The Materiality of Homeopathic Medicines. DynHom Research Program

Homeopathy is controversial because using highly dilute medicines (high homeopathic potencies, HHP) beyond the Avogadro/Loschmidt limit. Previous publications [1,2] using NMR relaxation revealed the involvement of nanobubbles and/or nanoparticles and/or nanometric superstructures in high potentizations. Nano Tracking Analyse (NTA) demonstrated the presence of particles in HHPs [3,4]. WithSEM-EDX [5] we observed an ionic diversity common to all preparations including HHPs and significant differences in the relative quantity of each ion between different homeopathic manufacturing lines and controls. FTIR spectroscopy [6] shows that the molecular composition is that of carbonates, primarily sodium bicarbonate.Methods:To observe the materiality of homeopathic medicines a multidisciplinary approach is necessary. In collaboration with several universities,we canobserve these medications with NMR, NTA, SEM-EDX, FTIR, pH,and EPA. Results:The essential component of all already studied homeopathic medicines is sodium hydrogen carbonate modulated by some other elements in a specific quantity, size,and shape. The probability that the observed results could have occurred just by random chance can be rejected(significantlyabove the Avogadro limit) p < 0,001.Conclusions:The homeopathic medicines do contain material with a specific ionic composition even in HHPs diluted beyond the Avogadro/Loschmidt limit. This specificity can be attributed to the manufacturing process. These results demonstrate that the step-by-step process (dynamized or not) does not match the theoretical expectations in a dilution process. The starting material and dilution/dynamization method influencethe nature of these NPs. The role of carbonates and sodium bicarbonate must be carefully studied in the future. Its aqueous solution is alkaline in nature but itis an amphoteric compound, which means that the compound has both acidic as well as alkaline character. The reaction with acids results in sodium salts and carbonic acid and the reaction with the basic solution producescarbonates and water. Specific electric fields are indeed detectable.

The immunoregulatory effect of co-3 polyunsaturated fatty acids on lymphocyte in cGVH mice / 中国药理学通报

Aim To investigate the effect of dietary intake of o)-3 poly unsaturated fatty acids ( u>-3 PUFAs) on the immune function of chronic graft versus host disease (cGVH) lupus model mice.Methods A single intraperitoneal injection of bml2 mice lymphocytes was used to establish a cGVH mouse model.On the day of modeling, 90% cd-3 PUFAs and 97% EPA were given by gavage for 14 days.The immune indexes of mice were evaluated by flow cytometry, and the serum total J J J ∗ IgG levels were measured by ELISA.Results Compared with control group, cGVH group significantly down-regulated Treg subsets, and up-regulated the Tfh , GC B and plasma subsets in the lupus mice.Comparer] with model control group, u>-3 PUFAs could significantly elevate Treg subsets, and decrease TFH, (X] B, and plasma subsets; serum total IgG levels in the 97% EPA group were significantly reduced.Conclusion In the cGVH lupus mouse model, co-3 PUFAs can suppress some immune functions by increasing Treg cells, reducing TFH, GC B, plasma cells and inhibiting the secretion of IgG.Such immunomodulatory effect provides new sights into the development of a potentially novel treatment modality for cGVH.

Risk estimation for lung cancer caused by indoor radon exposure in China based on EPA/BEIR-VI model / 中华放射医学与防护杂志

Objective:To estimate the attribution share of residents′lung cancer caused by indoor Radon.Methods:Based on the 2015 lung cancer mortality, all-cause mortality from China together with nationally representative smoking rate and the average indoor radon concentration of 30 Bq/m 3, the relatively authoritative and applicable EPA/BEIR-VI risk model was used to predict the lung cancer mortality caused by indoor radon exposure. Results:The excess relative risk (ERR) of indoor radon-related lung cancer mortality among the male non-smokers is higher than that of smokers. For the age-group above 50, the male smokers and male non-smokers have the highest ERR values, which were 0.511 and 0.230, respectively. Assuming the exposure incurred starting at age 0 with the same radon concentration, the lifetime risk of men and women non-smokers is higher than that of the smokers of the same gender. The higher the radon concentration, the higher the lifetime risk of lung cancer. Assuming that the radon concentration level in China is 30 Bq/m 3, the number of deaths from indoor radon-related lung cancer in 2015 is about 55 512. According to this, about 6.62% of lung cancers are caused by indoor radon exposure. If we assume that radon concentration levels are 40 Bq/m 3and 70 Bq/m 3 in China, approximately 8.82% and 15.38% of lung cancer deaths can be attributed to indoor radon exposure. Conclusions:Indoor radon exposure is an important environmental factor that causes Chinese residential lung cancer. Effective measures should be taken to prevent and control the increasing indoor radon levels. In order to accurately assess risk of lung cancer morality caused by indoor radon, more detailed data such as the indoor radon level in China are needed.

Equivalence of entrustable professional activities and context-dependent item sets as summative assessments in undergraduate physical therapy programs

Background@#Summative assessment of student performance should provide information on achievement of program outcomes to support evaluation decisions. Alternative approaches to the traditional assessment systems like the written licensure examinations in Physical Therapy (PT) should be explored to ensure valid measurement of achievement of these terminal outcomes. @*Objective@#The study aimed at establishing equivalence of two summative assessments new to PT in measuring achievement of the PT outcomes: work-based assessment using Entrustable Professional Activities (EPA) and knowledge-based assessment using Context-Dependent Item Sets (CDIS). @*Methodology@#Thirty-two newly graduated PT's underwent a one-week EPA assessment and took a 102-item CDIS test (based on 14 clinical vignettes). Qualitative data from blueprint review, group face-to-face interviews with participants and assessors, and field notes from observations, and quantitative data from EPA entrustment decisions and CDIS scores were utilized to ascertain their comparability in terms of Purpose, Administration, Quality and Decisions. This was used to determine the extent of equivalence of the two assessments. @*Results@#Review of both blueprints show alignment with PT outcomes, with integrative content motivating participants towards professional development. Administration were equally acceptable to users, though EPA had more practice opportunities with a longer assessment time. Entrustment decisions in EPA had a high inter-rater reliability, while CDIS had low reliability, with most items having poor discriminative power. Decisions of “pass” or “fail” had good concordance when high prevalence indices were considered. @*Conclusion@#There is high extent of equivalence in purpose of EPA and CDIS but are not equivalent in terms of administration. There is moderate equivalence in quality and decisions, with potential for increased concordance if improved quality of CDIS is attained.

Ácidos grasos en cepas de microalgas del Banco de Germoplasma de Organismos Acuáticos del Instituto del Mar del Perú (IMARPE)

Se determinó la composición de ácidos grasos de 54 cepas microalgales colectadas del Perú y mantenidas en el Banco de Germoplasma de Organismos Acuáticos (IMARPE) con la finalidad de determinar su uso nutricional en la acuicultura. Para ello se realizaron cultivos en un volumen de 50 mL y se determinaron los porcentajes relativos de ácidos grasos mediante transesterificación directa y cromatografía de gases. En el grupo Chlorophyta las microalgas que presentaron los mayores valores de porcentaje relativo de ácidos grasos fueron Chlamydomonas reinhardtii (16:0; 41.2%), Scenedesmus obtusus (18:1n-7; 33.6%), Acutodesmus dimorphus (18:1n-9; 37.1%), Desmodesmus armatus (18:3n-3; 32.2%) y Tetraselmis contracta (16:4n-3; 16.5%). En cambio en el grupo Bacillariophyta, los ácidos grasos más abundantes fueron 16:1n-7 en Chaetoceros didymus (20.2%), 18:4n-3 en Navicula sp. (28.3%) y EPA en Asterionellopsis sp. (31.5%). Por otro lado, en el grupo Dinophyta, todas las cepas superaron el 20% de DHA, en particular, la cepa de Akashiwo sanguinea presentó el mayor porcentaje relativo de este ácido graso (29.9%) y de los ácidos grasos 16:0 (24.8%) y EPA (16%). Se discute el uso de estas cepas según su contenido de ácidos grasos.

In This work, we determinate the fatty acids composition and their nutritional value in 54 microalgal strains, collected from Peru and stored in Banco de Germoplasma de Organismos Acuáticos (IMARPE). The cultures were grown to 50 mL and analyzed by direct transesterification and gas chromatography. In the Chlorophyta group, the microalgaes that present the highest relative percentage of fatty acids were Chlamydomonas reinhardtii (16:0; 41.2%), Scenedesmus obtusus (18:1n-7; 33.6%), Acutodesmus dimorphus (18:1n-9; 37.1%), Desmodesmus armatus (18:3n-3; 32.2%) and Tetraselmis contracta (16:4n-3; 16.5%). Moreover in the Bacillariophyta group, the most abundant fatty acids were 16:1n-7 in Chaetoceros didymus (20.2%), 18:4n-3 in Navicula sp. (28.3%) and EPA in Asterionellopsis sp. (31.5%). By the other hand, in the Dinophyta group, all strains exceed the 20% of DHA, in particular Akashiwo sanguinea, it was strain to have the highest percentage of this fatty acid (29.9%) in addition to 16: 0 (24.8%) and EPA (16%). We discussed uses of these strains is according to their fatty acids content.

Avaliação do perfil lipídico de ovos comerciais enriquecidos com omega 3 / Lipid profile of eggs with fatty acids omega 3

Objetivou-se com este estudo determinar o perfil de ácidos graxos de ovos comercializados como enriquecidos com ω3. Para o estudo foram adquiridas cartelas de uma dúzia de ovos de diferentes marcas comerciais. A determinação do perfil lipídico foi realizada a partir do ovo inteiro, sendo realizada a extração dos lipídeos, seguido de esterificação e análise cromatográfica para a identificação dos de ácidos graxos. Ocorreu uma maior variação entre os produtos para os ácidos graxos monoinsaturados e poli-insaturados. Para os teores de ácidos graxos ω3 ocorreu variação de 0,77 a 34,51%, principalmente para EPA que variou de 0,01 a 6,50% e, DHA que variou de 0,51 a 27,19%. Para ω6 os valores variaram de 5,35 a 21,91%. A quantidade de ácidos graxos ω3 em ovos enriquecidos é variável nos produtos, o que denota uma necessidade de padronização.

Perfil lipidico de produtos comercializados como fonte de omega 3 / Lipid profile of products with fatty acids omega 3

O presente estudo foi realizado com o objetivo de avaliar o perfil lipídico de produtos comercializados como enriquecidos com ácidos graxos ω3. Foi realizada a extração, esterificação e determinação cromatográfica dos ácidos graxos. Foram encontradas maiores concentrações dos ácidos graxos (C18:2ω6c), total de ácidos graxos ω6 e maior relação ω6/ ω3 para margarina. O salmão apresentou os maiores valores para os ácidos graxos C18:1ω9C, C18:3ω3 e total de monoinsaturados. Nas avaliações do suplemento foram encontradas as maiores concentrações dos ácidos graxos C20:5ω3 (EPA), C22:6ω3 (DHA) e total de ω3. Nos alimentos que são enriquecidos com ω3, a quantidade de EPA e DHA são baixas, sendo maiores de ácido linolênico (C18:3ω3). Nutricionalmente o suplemento de EPA e DHA e o salmão foram as melhores fontes de ácidos graxos ω3. E, todos os produtos apresentaram bons índices de aterogenicidade e trombogenicidade.

Review of Measurement Methods for Hearing Protector Attenuation

Abstract@#The attenuation degree labelled on hearing protectors is based on internationally set standards. The attenuation is measurement in laboratories using methodology of real-ear attenuation at threshold (REAT), microphone in-real ear (MIRE) and acoustics test feature (ATF). The measured attenuation gap from the actual workplace is a problematic predicament. The conceptual review of how far these methods affect the gap could embark future researches. Therefore, a conceptual review of the conducted methodologies according to standards for attenuation which include Noise Reduction Rating (NRR) and Single Number Rating (SNR) are discussed in this paper. 23 papers from ProQuest, EBSCOhost and Google Scholar databases are chronologically reviewed. Summarily, the improved attenuation measurement methods will help close the gap between laboratory data and field performance and subsequently will better prevent Noise-Induced Hearing Loss. Most of the latest findings after year 2010 were in agreement with the studies in 2000 to 2009.

Behavioral Differences of Japanese and Indonesian nurses under Economic Partnership Agreements (EPA) for Solving Oriented Problems in Nursing Practice / 国際保健医療

Objective  In Japan, the low pass rate of Economic Partnership Agreements (EPA) foreign nurse candidates in the National Nursing Examination is a serious issue because it suggests differences in nursing practice between the countries. This study aimed to reveal the discrepancy in nursing practice between Indonesian and Japanese nurses.Methods   Questionnaires were sent to 9 hospitals to collect data from Indonesian and Japanese nurses working together. It included the “Self-evaluation Scale on Oriented Problem Solving Behavior in Nursing Practice” to measure the quality of problem-solving behaviors.Results  Participants were 17 Indonesian (8 males, 9 females; average age: 30.6 years) and 50 Japanese nurses. Of them, 9 Indonesian nurses had not passed the National Nursing Exam. No remarkable difference was observed between the Indonesian and Japanese nurses on any of the sub-scales of the problem-solving scale. However, after matching the groups with nursing experience years (by selecting Japanese nurses with an experience of less than 10 years, n＝22), a notable difference was observed in “Securing consent from the patient for providing nursing care,” with Indonesian nurses who had not yet passed the National Nursing Exam scoring significantly lower than Japanese nurses (p＝0.01 for the Wilcoxon test with Bonferroni correction). While Japanese nurses assist patients with activities of daily living, the patient’s family is mainly responsible for such care in Indonesia. Therefore, Indonesian nurses do not fully acknowledge their need to secure consent in providing daily life assistance to patients.Conclusion   Indonesian nurses who had not passed the National Nursing Exam scored significantly lower on “Securing consent from the patient for providing nursing care.” Therefore, it is recommended to provide them education to enable them to recognize the importance of practicing nursing based on nursing plans that consider patients’ needs.

The occurrence and characteristics of ectopic pituitary adenoma in China / 中华内分泌外科杂志

Objective To determine the occurrence and clinical characteristics of ectopic pituitary adenoma (EPA) in China.Methods The study are done by searching systematically and comprehensively on major Chinese and English medical literature databases and conference papers before 2015,which are only limited to collected,summarized,sorted and analyzed EPA cases that reported by Chinese authors in English or Chinese occurred in China.Results ① Among the 86 Chinese articles and 27 English articles related to ectopic pituitary adenoma (EPA) gathered by the author,except for cases that have been confirmed as repeated reports,a total of 73 EPA cases were found.Of 70 cases with complete data,31 were male cases,accounting for 44.29％;39 were female cases,accounting for 55.71％;the ratio is 1:1.3.The frequency of EPA occurrence according to the location of the lesion,from high to low in turn,was sphenoid sinus (31 cases,42.47％),nasopharynx (7 cases,9.59％),suprasellar region (7 cases,9.59％),clivus (5 cases,6.85％),followed by the third ventricle,sphenoid sinus/clivus,nasal cavity,and the temporal lobe of the brain,with the same incidence of 4.11％.According to the functional properties of EPA,the frequency of different secreting hormones adenoma was PRL-ma(21 cases,28.77％),NF-ma (21 cases,28.77％),ACTH-ma (15 cases,20.55％),GH-ma (10 cases,13.70％),TSH-ma (2 cases,2.74％) and FSH-ma (1 cases.1.37％).Three cases of EPA were uncertain in their property due to lack of information.The incidence of PRL and nonfunctional tumors was the highest,which was different from what was reported in other countries.Among them,one case of EPA was in pineal region and one in parapharyngeal space,which was even more rare and were never reported abroad.(② Except for 3 cases with incomplete medical records,15 out of 70 cases of EPA were accompanied by empty sella,accounting for 21.43％,among which 11 (73.33％) cases involved the sphenoid sinus,and 3 (20％) cases involved clivus.The sphenoid sinus and clivus cases together accounted for 93.33％.(③ 29 out of the 69 cases of EPA with complete record were invasive pituitary adenomas,accounting for 42.03％ and including 1 case of pituitary adenocarcinoma,which accounted for 1.45％.(④ All cases were treated with surgery as the first choice,and some of them were treated with radiotherapy or drug therapy.Conc lusion Ectopic pituitary adenoma is extremely rare.By the end of 2015,the total number of cases reported in China is only 73,which are mostly located in the sphenoid sinus,suprasellar region and nasopharynx.In the functional classification,the most common types are still PRL adenoma and nonfunctional adenoma as in situ pituitary adenoma.42.03％ of EPA adenomas are invasive.Surgical resection of EPA is the first choice and some cases can be treated with radiotherapy and drug therapy.

Risk Assessment of “Other Substances” –Eicosapentaenoic Acid, Docosapentaenoic Acid and Docosahexaenoic Acid

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the risk of “other substances” in food supplements and energy drinks sold in Norway. VKM has assessed the risk of doses given by NFSA. These risk assessments will provide NFSA with the scientific basis while regulating the addition of “other substances” to food supplements and other foods. “Other substances” are described in the food supplement directive 2002/46/EC as substances other than vitamins or minerals that have a nutritional or physiological effect. The substance is added mainly to food supplements, but also to energy drinks and other foods. VKM has not in this series of risk assessments of “other substances” evaluated any potential beneficial effects from these substances, only possible adverse effects. The present report is a risk assessment of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) in food supplements, and is based on previous risk assessments and a literature search. It is emphasised that this risk assessment concerns the single fatty acids EPA, DPA or DHA separately and not mixtures of these as found in e.g. fish oil/cod liver oil. For risk assessment of combined mixtures of n-3 LCPUFAs in e.g. fish oil/cod liver oil, see the EFSA opinion from 2012 or the VKM assessment from 2011 (EFSA, 2012; VKM, 2011). In the reviewed literature of this risk assessment, no studies investigating ratios between EPA, DPA, DHA or other fatty acids in mixtures have been identified. EPA, DPA and DHA are long chain n-3 polyunsaturated fatty acids (n-3 LCPUFA) and in food these fatty acids are incorporated in triacylglycerols (TAGs) and phospholipids (PLs). Dietary sources are fatty fish, cod liver-, seal-, whale-, fish- and krill oils and human milk, containing various ratios of these fatty acids in combination. EPA can be metabolised to eicosanoids such as prostaglandins, prostacyclins and leukotrienes, all groups are biologically active substances. The eicosanoids participate in the regulation of blood pressure, renal function, blood coagulation, inflammatory and immunological reactions. DHA is an essential structural component of the brain, skin, sperm, testicles and retina. DPA can be retro-converted to EPA or converted to DHA. Still little is known of the biological effects of DPA. Humans have a limited capacity to synthesise EPA, DPA and subsequently DHA from the precursor alpha-linolenic acid (ALA), and this endogenous production is negligible in comparison to the doses used in supplementation studies. According to information from the NFSA, EPA, DPA and DHA are food supplement ingredients in Norway, and NFSA has requested a risk assessment of these fatty acids in the following doses in food supplements: EPA: 1500, 1750 and 1825 mg/day DPA: 100, 125 and 150 mg/day DHA: 1050 and 1290 mg/day Children below 10 years were not included in the terms of reference. Information about intake of EPA, DPA and DHA from the diet is scarce, but calculations performed in the Norwegian Mother and Child Cohort Study indicate a mean total intake (SD) from food and supplements of EPA around 330 (340) mg/day, DPA 43 (30) mg/day and DHA 430 (380) mg/day among pregnant women (2002 to 2008). Mean combined intake of EPA, DPA and DHA from fish oil/ cod liver oil in adults participating in a nationally representative dietary survey was 735 mg/day (VKM, 2014). The major concerns with high intake of EPA and DHA have been increased bleeding time, adverse effects related to immune function, lipid peroxidation and glucose homeostasis. EFSA concluded in 2012 that long-term supplemental intakes of 5 g/day of the n-3 LCPUFA do not raise safety concerns for adults with regard to an increased risk of spontaneous bleeding episodes or bleeding complications, or affect glucose homeostasis, immune function or lipid peroxidation. In 2011, VKM concluded that an intake n-3 LCPUFA up to 6.9 g/day was not associated with increased risk of any serious adverse events. Some adverse health effects related to gastrointestinal function, including abdominal cramps, flatulence, eructation, vomiting and diarrhea have been reported, but seem to be associated with intake of an oily substance and not related specifically to EPA, DPA and/or DHA. EPA: In the report from 2012, EFSA concluded that 1.8 g/day of supplemental EPA does not raise safety concerns in adults. None of the included studies from our literature searches limited to 2012 and onwards have investigated bleeding complications. The dosages of EPA in the three included studies in this report range from 1.8 to 3.8 g/day for 12 weeks. The main endpoints in the studies included lipid peroxidation, inflammation biomarkers of cardiovascular diseases and no serious adverse events were found related to the main endpoints. In general, adverse events were described as gastrointestinal discomforts and not related to dosage. Studies of longer duration are necessary before an intake above 1.8 g of EPA can be considered safe. The Norwegian Scientific Committee for Food Safety (VKM) concludes that the specified doses of 1500, 1750, 1825 mg/day of EPA in food supplements are unlikely to cause adverse health effects in adults (≥18 years). In 2012, EFSA did not make conclusions for children or adolescents for EPA. No new studies with EPA supplementation have been identified in children or adolescents after 2012, and therefore no risk assessment can be made for children (≥10 years) or adolescents. DPA: No dosage of DPA in food supplements can be evaluated due to lack of data. DHA: EFSA concluded that 1 g/day of supplemental DHA does not raise safety concerns for the general population (including children and adolescents). The dosages of DHA in the included trials in this report range from 1.0 to 3.6 g/day and the duration from five weeks to four years. Six out of seven studies have used dosages from 1 to 2 g DHA/day. The last study included up to 3.6 g DHA/day for four years and the age spanned from 7 to 31 years. The main endpoints in all studies included lipid peroxidation, inflammation, cognitive performance, blood pressure and biomarkers of cardiovascular diseases and no serious adverse events were found related to the main endpoints. In general, adverse events were described as gastrointestinal discomforts and not related to dosage. VKM therefore considers that the specified daily doses of DHA that moderately exceed 1 g per day (1050 and 1290 mg/day) are unlikely to cause adverse health effects in the general population including children ≥10 years and adolescents. VKM concludes that the specified doses of 1050 and 1290 mg/day of DHA in food supplements are unlikely to cause adverse health effects in the general population including children (≥10 years), adolescents and adults (≥18 years).

Actividades profesionales confiables en cirugía mínimamente invasiva: iniciando el camino para lograr competencias en el futuro graduado de medicina / Entrustable professional activities in minimally invasive surgery: starting the way to achieve competencies in the future medical graduate

Objetivos: El desarrollo de actividades profesionales confiables (APROC) para el graduado de medicina en Cirugía Mínimamente Invasiva (CMI) es una necesidad en Colombia. La evidencia disponible es limitada. Este estudio describe la experiencia preliminar con una intervención orientada a esta necesidad, en el marco de un modelo de educación basada en competencias (EBC). Materiales y Métodos: Se diseñó una intervención orientada al desarrollo de actitudes, conocimientos y habilidades prácticas en CMI para estudiantes de medicina, mediante un enfoque de aula invertida extendida. Se realizaron evaluaciones pre y posintervención mediante el cuestionario Team-STEPPS (actitudes), exámenes de conocimiento y OSATS (habilidades prácticas). Se realizaron comparaciones pre y posintervención (t-test (p < 0,05) y mediciones del tamaño del efecto de la intervención (prueba d Cohen). Finalmente se evaluó la satisfacción estudiantil. Resultados: Un total de 99 estudiantes participaron en el estudio. Se encontraron diferencias estadísticamente significativas (p < 0,05) entre las mediciones pre y posintervención, y gran efecto en las actitudes, conocimientos y habilidades prácticas (d > 0,80). Se evidenció alta satisfacción estudiantil. Discusión: El diseño instruccional a través de metodologías interactivas permite desarrollar APROC en CMI, desde el pregrado. Estos resultados son similares a los reportados en otras intervenciones en el marco de la EBC. Conclusión: Nuestra intervención demostró efectos positivos sobre competencias estudiantiles orientadas al desarrollo de APROC en CMI para el futuro graduado. Aun es necesario medir estas competencias en la práctica real y al finalizar la carrera, para determinar si estas actividades pueden ser totalmente confiables a los participantes en su futura práctica profesional.

Aims: The development of entrustable professional activities (EPAs) in minimally invasive surgery (MIS) for undergraduates is a need in Colombia. The available evidence is limited. This study aims to describe the preliminary experience with an intervention oriented to this need, embedded in the framework of a competence-based education model (CBE). Materials and Methods: An intervention was designed for the development of EPAs in MIS oriented to the development of attitudes, knowledge and practical skills in medical students. Intervention was delivered through an extended inverted classroom approach. Pre- and postintervention measures were performed by using the Team-STEPPS questionnaire (attitudes), knowledge assessments and OSATS (practical skills). Comparisons were performed by t-test tests (p < 0.05) and the effect size of the intervention was calculated by the Cohen d test. Finally, the student's satisfaction was evaluated. Results: A total of 99 students participated in the study. The intervention showed statistically significant differences (p < 0.05), and great effect on attitudes, knowledge and practical skills (d > 0.80). Likewise, high student satisfaction was evidenced. Discussion: Interactive instructional design fosters development of EPAs in MIS for medical undergraduates. These results are similar to those reported in other interventions under the CBE model. Conclusion: Our intervention showed positive effects on competences oriented to the development of EPAs in MIS for the future graduate. Still is necessary to assess these competencies in real practice and at the end of medical career, in order to evaluate if these activities can be totally reliable to the participants in their future professional practice.

Água-régia como extrator alternativo para o diagnóstico ambiental de áreas impactadas por resíduos industriais: estudo de caso Centres (Queimados, RJ) / Aqua regia as an alternative extractor for the environmental diagnosis of areas impacted by industrial waste: case study Centres (Queimados, RJ)

RESUMO Áreas contaminadas por metais podem configurar sério risco à saúde pública e ao meio ambiente. Na década de 1980 foi instalado um pátio de estocagem provisória de resíduos industriais perigosos (CENTRES), no município de Queimados, Rio de Janeiro, o que causou um grande impacto ambiental ao solo da região. A legislação brasileira para o diagnóstico de áreas contaminadas limita a extração de metais em solos aos métodos recomendados pela United States Environmental Protection Agency (USEPA) 3050 e 3051A. Entretanto, muitos pesquisadores utilizam o método com água-régia para a extração de metais em solo, mas são escassos estudos que comparem as concentrações de metais extraídos por água-régia e USEPA 3051A. Logo, o objetivo deste trabalho foi avaliar se o método de extração de metais em solos por água-régia é estatisticamente diferente do método USEPA 3051A. Os resultados obtidos revelaram que as concentrações de Cd, Cr, Cu, Ni, Pb e Zn utilizando ambas as extrações (água-régia e USEPA 3051A) foram estatisticamente semelhantes. Também foi possível identificar que as concentrações de Cu, Ni, Pb e Zn foram superiores ao valor de investigação industrial, o que caracteriza essa área como altamente contaminada e solo classe 4.

ABSTRACT Metal contaminated areas lead to environmental and public health risks. In the 1980s, dangerous industrial waste storage was initiated in the CENTRES area in the municipality of Queimados, Rio de Janeiro, Brazil. The inadequate management of these wastes has promoted a large environmental impact to this region's soils. The Brazilian legislation for diagnostics of contaminated areas limits the extraction of metals on soils to USEPA 3050-B and USEPA 3051-A methods. However, many researchers use the aqua regia method for extracting metals in soil, but there are few studies comparing concentrations of metals extracted by aqua regia and USEPA 3051A. Therefore, the objective of this work was to evaluate if the method of extracting metals in soils by aqua regia is statistically different from US EPA 3051A. The results showed that the Cd, Cr, Cu, Ni, Pb and Zn concentrations using both extractions were statistically similar. It was also observed that Cu, Ni, Pb and Zn concentrations were higher than the industrial investigation value which characterizes this area as highly contaminated and soil class 4.

Effectiveness of omega-3 polyunsaturated fatty acids against microbial pathogens / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Microorganisms provide both beneficial and harmful effects to human beings. Beneficial effects come from the symbiotic relationship that exists between humans and microbiota, but then several human illnesses have turned some friendly microbes into opportunistic pathogens, causing several microbial-related diseases. Various efforts have been made to create and utilize antimicrobial agents in the treatment and prevention of these infections, but such efforts have been hampered by the emergence of antimicrobial resistance. Despite extensive studies on drug discovery to alleviate this problem, issues with the toxicity and tolerance of certain compounds and continuous microbial evolution have forced researchers to focus on screening various phytochemical dietary compounds for antimicrobial activity. Linolenic acid and its derivatives (eicosapentaenoic acid and docosahexaenoic acid) are omega-3 fatty acids that have been studied due to their role in human health, being important for the brain, the eye, the cardiovascular system, and general human growth. However, their utilization as antimicrobial agents has not been widely appreciated, perhaps due to a lack of understanding of antimicrobial mechanisms, toxicity, and route of administration. Therefore, this review focuses on the efficacy, mechanism, and toxicity of omega-3 fatty acids as alternative therapeutic agents for treating and preventing diseases associated with pathogenic microorganisms.

Occupational Stress among Nurses Working in Japan Through the Economic Partnership Agreement (EPA) / 日本プライマリ・ケア連合学会誌

Introduction: This study aimed to clarify the stress experienced by nurses working at hospitals in Japan through the Economic Partnership Agreement (EPA).Methods: A questionnaire survey that included a brief job stress questionnaire and sense of coherence (SOC) scale was administered to EPA nurses and nursing candidates.Results: Seventy-two nurses and nursing candidates responded to the survey. Overall, 79.2% of them felt confused about the differences between work in Japan and in their home country and they experienced qualitative and physical burdens as a result of their job. Female respondents rated the "suitability of the job" as relatively low, whereas male respondents rated the "degree of utilization of skills" as relatively low. Both male and female respondents received strong support from their families and friends. A correlation analysis of the data regarding female respondents indicated that occupational stress was related to how accustomed they had become to life in Japan, their Japanese language ability, quantitative burden of the job, workplace environment, and SOC.Conclusions: The study results suggested that considerations of the burden of the job, workplace environment, and improvement in SOC should be required from workplaces that accept EPA nurses.

Interferências da suplementação de óleo de peixe na qualidade de vida de pacientes em tratamento neoadjuvante de carcinoma de reto / Interferences of fish oil supplementation in the quality of life of patients in neoadjuvant treatment for rectum carcinoma

Introdução: Segundo a Organização Mundial de Saúde qualidade de vida (QV) compreende "a percepção do ser humano de sua posição na vida no contexto da cultura e sistema de valores nos quais ele vive e em relação aos seus objetivos, expectativas, padrões e preocupações". Já foi comprovado os benefícios da terapia neoadjuvante na redução do risco de recorrência local, melhora da margem de ressecção cirúrgica e maiores chances de cura através da resposta patológica completa. Porém, apesar dos benefícios desses tratamentos, existem efeitos adversos relacionados à toxicidade e complicações cirúrgicas e pós-cirúrgicas que interferem drasticamente na qualidade de vida dos pacientes. Em estudos pré-clínicos a incorporação de ácidos graxos eicosapentaenoico (EPA) e docosaexaenoico (DHA) - provenientes do óleo de peixe - tem mostrado interferir em vias de inflamação, sinalização celular e transcrição gênica melhorando a resposta ao tratamento e consequentemente a qualidade de vida. Objetivo: O objetivo primário desta pesquisa foi verificar se o consumo diário de 2,4g de EPA+DHA concomitante a terapia neoadjuvante e até um dia antes da cirurgia interferiria na qualidade de vida de pacientes com câncer de reto durante o tratamento. Os objetivos secundários foram avaliar complicações intra e pós-cirúrgicas, resposta patológica e estado nutricional dos pacientes e relacionar essas informações com qualidade de vida e ingestão de óleo de peixe. Metodologia: Um total de 111 pacientes com adenocarcinoma de reto foram randomizados quanto à suplementação diária de 2,4 g de EPA+DHA concomitante ao tratamento neoadjuvante. Após necessidade de exclusão de alguns pacientes 106 estavam aptos para participação das avaliações do projeto, que aconteceram em cinco momentos: M1 - pré-tratamento, M2 - ao termino da quimioradioterapia, M3 - quatro semanas após quimioradioterapia e M4 - um dia antes da cirurgia. No pós-operatório as informações foram adquiridas através do prontuário eletrônico. A qualidade de vida foi avaliada através dos questionários da Organização Europeia de Pesquisa e Tratamento do Câncer, EORTC QLQ-C30 e QLQ-CR29, que foram aplicados em todos os momentos do estudo. Resultados: Não houve diferenças significativas entre os grupos controle (GC) e o grupo intervenção (GI) quanto as características sociodemográficas e clínicas. Com relação às variáveis do estado nutricional foi possível perceber que a quimioradioterapia resultou em deterioração do estado nutricional em ambos os grupos sendo percebida melhora do estado nutricional no M3 e M4, não havendo, porém, diferenças significativas entre os grupos para todas as variáveis. Os resultados dos questionários de qualidade de vida mostraram no M1 (primeira avaliação) que o GC se apresentava mais sintomático para disúria (P = 0,041) e distensão abdominal (P = 0,036), sendo que ao final da radio e quimioterapia o sintoma disúria permaneceu prevalente para o GC (P = 0,031). No M3 o GI apresentou-se menos sintomático para dor (P = 0,045), dor anorretal (P = 0,009) e dispaurenia (P = 0,041), e para escala de função apresentou menos ansiedade (P = 0,033) quando comparados ao GC. Um dia antes da cirurgia (M4) o GC apresentou-se com maior perda de apetite (P = 0,016) e distensão abdominal (P = 0,007) quando comparado com o GI. Com relação aos efeitos adversos do tratamento neoadjuvante o GI apresentou-se com menor quantidade de sintomas relatados do que o GC (P = 0,045). Conclusão: A suplementação com EPA e DHA em pacientes com câncer de reto melhorou a QV ao diminuir disúria, dor, dor anorretal, dispaurenia, distensão abdominal, perda de apetite e ansiedade quando comparados ao GC e interferiu nos efeitos adversos da RDT e QT ao diminuir significativamente a quantidade de toxicidades relatadas pelos pacientes do GI quando comparados ao GC (AU)

Introduction: According to the Health World Organization, Quality of Life (QoL) comprises "the perception of a human being regarding their position in life in the context of culture and a value system in which they live, related to their goals, expectations, standards and concerns". The benefits of neoadjuvant therapy have already been proven, such as risk reduction of local recurrence, margin improvement of surgical resection and greater chances of cure through the complete pathological response. However, despite the benefits of these treatments, there are adverse effects related to toxicity and surgical and post-surgical complications which drastically interfere with patient's quality of life. In pre-clinical studies, the incorporation of fatty acids as eicosapentaenoic (EPA) and docosahexaenoic (DHA) ­ derived from fish oil ­ have shown to interfere in inflammation pathways, cellular signaling and gene transition, improving treatment response and therefore the quality of life. Objective: The primary goal of the present research was to verify if daily consumption of 2,4 g of EPA+DHA concomitant to neoadjuvant therapy and up to one day before surgery would interfere in patient's quality of life during treatment. The secondary objectives were to assess intra and post-surgical complications, pathological response and nutritional state of patients and to relate this information with quality of life and fish oil intake. Method: A total of 111 patients with rectum adenocarcinoma were randomly assigned for daily supplementation of 2,4 g of EPA+DHA concomitant to neoadjuvant treatment. After the need for exclusion of some patients 106 were suitable for participation in the projects assessments, which occurred in five moments: M1 ­ pre-treatment, M2 ­ at the end of chemoradiotherapy, M3 ­ four weeks after chemoradiotherapy and M4 ­ one day before surgery. At post-operative information were obtained through electronic record. Quality of life was assessed through the European Organization of Research and Treatment for Cancer, EORTC QLQ-C30 and QLQ-CR29, which were applied in all moments of the study. Results: There were no significant differences between control group (CG) and intervention group (IG) regarding sociodemographic and clinical characteristics. About nutritional state variables, it was possible to notice that chemoradiotherapy resulted in the deterioration of the nutritional state in both groups, improvement of the nutritional state was noticed in M3 and M4, however, there were no significant differences among groups for all variables. The results of quality of life questionnaires showed that in M1 (first assessment) the CG was presented more symptomatic for dysuria (P = 0,041) and abdominal distention (P = 0,036), in that at the end of radio and chemotherapy the dysuria symptom remained prevalent for CG (P = 0,031). In M3 the IG was presented less symptomatic for pain (P = 0,045), anorectal pain (P = 0,009) and dyspareunia (P = 0,041), and for scale function presented less anxiety (P = 0,033) when compared to the CG. One day before surgery (M4) the CG presented greater loss of appetite (P = 0,016) and abdominal distention (P = 0,007) when compared to the IG. Regarding adverse effects of neoadjuvant treatment, the IG presented less quantity of reported symptoms than the CG (P = 0,045). Conclusion: The supplementation with EPA and DHA in patients with rectum cancer improved QoL by decreasing dysuria, pain, anorectal pain, dyspareunia, abdominal distention, loss of appetite and anxiety when compared to the CG and interfered in the adverse effects of chemoradiotherapy by significantly decreasing the amount of toxicity reported by the IG patients when compared to the CG (AU)

Selection of Schizochytrium limacinum mutants based on butanol tolerance

Background: Mutation breeding is one of the most important routes to achieving high docosahexaenoic acid (DHA) productivity using Schizochytrium. However, few selection strategies have been reported that aim to generate a high DHA content in Schizochytrium lipids. Results: First, culture temperature altered the butanol tolerance of Schizochytrium limacinum B4D1. Second, S. limacinum E8 was obtained by selecting mutants with high butanol tolerance. This mutant exhibited a 17.97% lower proportion of DHA than the parent strain S. limacinum B4D1. Third, a negative selection strategy was designed in which S. limacinum F6, a mutant with poor butanol tolerance, was obtained. The proportion of DHA in S. limacinum F6 was 11.22% higher than that of parent strain S. limacinum B4D1. Finally, the performances of S. limacinum B4D1, E8 and F6 were compared. These three strains had different fatty acid profiles, but there was no statistical difference in their biomasses and lipid yields. Conclusion: It was feasible to identified the relative DHA content of S. limacinum mutants based on their butanol tolerance.

Análise de risco de contaminação de águas subterrâneas por resíduos de agrotóxicos no município de Campo Novo do Parecis (MT), Brasil / Risk analysis of groundwater contamination by pesticide residues in Campo Novo do Parecis (MT), Brazil

RESUMO Considerando a possibilidade de que os agrotóxicos utilizados nas principais culturas, como soja, algodão e milho, podem gerar resíduos que contaminam o meio ambiente, faz-se necessária uma análise preliminar sobre a possibilidade de contaminação das águas subterrâneas por resíduos de agrotóxicos utilizados nas principais regiões agrícolas do país. Uma dessas áreas agrícolas se localiza na cidade de Campo Novo do Parecis, Mato Grosso, região de estudo deste trabalho. Os principais agrotóxicos aplicados nas diferentes culturas da região foram avaliados quanto às suas propriedades físico-químicas, seus potenciais de contaminação de acordo com critérios da Agência de Proteção Ambiental dos Estados Unidos e pelo índice de vulnerabilidade de águas subterrâneas (GUS). As informações obtidas foram empregadas para avaliar o risco de contaminação das águas subterrâneas. De acordo com os resultados encontrados, a região apresenta risco real de contaminação ambiental por resíduos de agrotóxicos, uma vez que 45,6% dos agrotóxicos comumente empregados na agricultura local são classificados como extremamente tóxicos ou altamente tóxicos. Além disso, vários desses ingredientes aditivos, cerca de 22%, já foram detectados em diferentes compartimentos ambientais de outras regiões do estado de Mato Grosso.

ABSTRACT Considering the possibility that pesticides used in main crops, such as soybeans, cotton and corn, generate toxic residues that contaminate the environment, a preliminary analysis of the possibility of groundwater contamination is necessary in the main agricultural regions in Brazil. One of these agricultural areas is located in Campo Novo do Parecis, Mato Grosso, the study area of this work. The main pesticides used in different cultures of this region were evaluated considering their physicochemical properties, their contamination potentials according to criteria of the Environmental Protection Agency of the United States and the groundwater ubiquity score index (GUS). The information obtained was used to assess the risk of groundwater contamination. According to the results, the region presents a real risk of environmental contamination by pesticide residues, since 45.6% of the pesticides commonly used in local agriculture are classified as extremely toxic or highly toxic. In addition, several of these pesticides, about 22%, have been detected in different environmental compartments from other regions of the state of Mato Grosso, Brazil.

A single administration of fish oil inhibits the acute inflammatory response in rats

OBJECTIVE@#To investigate the antiinflammatory effects of a single administration of fish oil (FO) on the acute inflammatory response.@*METHODS@#The paw edema and pleurisy models were used to evaluate the effects of FO dissolved in olive oil (FOP) orally administered in a single dose in rats. Nitric oxide (NO) concentrations in the pleural exudate were performed according to the Griess method and the cytokine concentrations were determined by Luminex bead-based multiplex assay.@*RESULTS@#FOP treatment (30 and 300 mg/kg) significantly reduced paw edema. FOP treatment at 18.75, 37.5, 75.0, 150.0, and 300 mg/kg decreased both the volume of pleural exudate and cellular migration into the pleural cavity and each of these doses presented the same effectiveness. Treatment with FOP (300 mg/kg) reduced NO, TNF-α, IL-1β, and IL-6 concentrations in the pleural exudate.@*CONCLUSIONS@#The present data provide evidence that FO has inhibitory effects on the acute inflammatory response when administered in a single dose in rats. This effect might be attributable to a direct inhibitory effect of FO on the production or release of inflammatory mediators that are involved in the pathological processes evaluated herein.

A single administration of fish oil inhibits the acute inflammatory response in rats

Objective To investigate the antiinflammatory effects of a single administration of fish oil (FO) on the acute inflammatory response. Methods The paw edema and pleurisy models were used to evaluate the effects of FO dissolved in olive oil (FOP) orally administered in a single dose in rats. Nitric oxide (NO) concentrations in the pleural exudate were performed according to the Griess method and the cytokine concentrations were determined by Luminex bead-based multiplex assay. Results FOP treatment (30 and 300 mg/kg) significantly reduced paw edema. FOP treatment at 18.75, 37.5, 75.0, 150.0, and 300 mg/kg decreased both the volume of pleural exudate and cellular migration into the pleural cavity and each of these doses presented the same effectiveness. Treatment with FOP (300 mg/kg) reduced NO, TNF-α IL-1β and IL-6 concentrations in the pleural exudate. Conclusions The present data provide evidence that FO has inhibitory effects on the acute inflammatory response when administered in a single dose in rats. This effect might be attributable to a direct inhibitory effect of FO on the production or release of inflammatory mediators that are involved in the pathological processes evaluated herein.