Effect of response interruption and redirection as a behavioral intervention on vocal stereotypy in children with autism spectrum disorder: a scoping review / 中国康复理论与实践

ObjectiveTo review the effect of response interruption and redirection intervention on vocal stereotypy in children with autism spectrum disorder (ASD). MethodsLiteratures on response interruption and redirection intervention for vocal stereotypy in children with ASD were retrieved from databases of EBSCO, PubMed, Web of Science, CNKI, and Wanfang data. The information of the literatures was extracted to conduct a scoping review. ResultsA total of 16 English literatures were included. All researches employed a single-subject time series study design. A total of 41 children with ASD were involved. Significant differences were found in levels of basic verbal functioning of children with ASD. Vocal stereotypy was characterized by both verbal and nonverbal forms. Most of the reviewed researches used experimental functional assessment to analyze the function of vocal stereotypy. In most cases, the function of vocal stereotypy was automatic reinforcement. Iwata et al.'s paradigm was dominantly adopted in performing experimental functional assessment across researches. Other related paradigms developed based on Iwata et al.'s paradigm to make operating process more concise were also used for experimental functional assessment in reviewed researches. Response disruption and redirection was often conducted in individualized setting, with a few researches conducted in special education classes. The time and frequency of interventions varied widely across subjects due to the levels of impairment in vocal stereotypy and other behaviors. According to a comparison of the effects of traditional response interruption and redirection and its morphing procedures, it was found that changing the content of the redirection task, reducing the number of redirection tasks, and varying the duration of execution did not impact the improvement of vocal stereotypy. Based on the comparisons of response interruption and redirection with matched stimuli, response cost, verbal manipulation training, and medication, it was found that both response interruption and redirection and other methods (except for medication) could reduce vocal stereotypy and promote the emergence of appropriate behaviors in children with ASD. Combining response interruption and redirection with other techniques, such as stimulus matching and response costs, yielded more favorable improvement of vocal stereotypy in children with ASD. ConclusionASD children with vocal stereotypy show different levels of functional language, and vocal stereotypy is generally characterized by both verbal and nonverbal formats. The function of vocal stereotypy is mostly automatic reinforcement. Response interruption and redirection as a behavioral intervention is mostly conducted in individualized setting, and the time and frequency of interventions depend on the levels of vocal stereotypy and other behaviors problems. Changing the content and number of redirection instructions does not significantly influence the improvement of vocal stereotypy in children with ASD. Other intervention methods such as matching stimulus and response cost are able to reduce vocal stereotypy in children with ASD, but response interruption and redirection used in conjunction with these methods show more favorable improvements. Response interruption and redirection interventions can not only reduce vocal stereotypy in children with ASD, but also increase appropriate vocalizations, task engagement and command obedience.

Multitasking in postanesthesia care unit following nurse interruptions, an analysis of the causes and consequences using classification tree: an observational prospective study

Abstract Background: Postanesthesia Care Unit (PACU) is an environment associated with an important workload which is susceptible to lead to task interruption (TI), leading to task-switching or concurrent multitasking. The objective of the study was to determine the predictors of the reaction of the nurses facing TI and assess those who lead to an alteration of the initial task. Methods: We conducted a prospective observational study into the PACU of a university hospital during February 2017. Among 18 nurses, a selected one was observed each day, documenting for each TI the reaction of the nurse (task switching or concurrent multitasking), and the characteristics associated with the TI. We performed classification tree analyses using C5.0 algorithm in order to select the main predictors of the type of multitasking performed and the alteration of the initial task. Results: We observed 1119 TI during 132 hours (8.5 TI/hour). The main reaction was concurrent multitasking (805 TI, 72%). The short duration of the task interruption (one minute or less) was the most important predictor leading to concurrent multitasking. Other predictors of response to TI were the identity of the task interrupter and the number of nurses present. Regarding the consequences of the task switching, long interruption (more than five minutes) was the most important predictor of the alteration of the initial task. Conclusions: By analysing the predictors of the type of multitasking in front of TI, we propose a novel approach to understanding TI, offering new perspective for prevention strategies.

Study on the reasons of the interruption of Chinese residents' physical fitness behavior / 中华行为医学与脑科学杂志

Objective:To discusses the formation mechanism and influencing factors of sports fitness behavior interruption.Methods:From January 1st to April 30th in 2015, the adults aged 20 and above in the national survey of fitness activities were selected as the research objects to analyze the reasons for the interruption of fitness behavior of Chinese residents, including 32 877 people with fitness habits and 5 152 people with interrupted fitness habits.SPSS 19.0 and AMOS 17.0 software were used to process the data.The chi-square test was used to analyze the characteristics and changing trend of people who interrupted physical fitness behavior.Correlation analysis and factor analysis were used to categorize public factors of residents' physical fitness behavior characteristics.Validating factor analysis and path analysis were used to analyze the main reasons affecting the disruption of residents' physical fitness behaviors.Results:The fitness interruption behavior among Chinese residents were statistically significant different in terms of age, gender, and habitation( χ2=2.791, 199.435, 12.402, all P<0.05). The highest percentage of fitness interruptions was observed among residents aged 20-39 (19.1%) in China, women (16.2%) were higher than men (15.5%), and urban (16.4%) were higher than rural (14.9%). Factor classification and model analysis showed that the occurrence of disruptions in physical fitness behavior among Chinese residents was influenced by a combination of health factors( β=0.52), social environment( β=0.57), psychological factors( β=0.42), and fitness behavior environment( β=0.22). Conclusion:The occurrence of disruption of physical fitness behavior of our residents is mainly influenced by the combination of health factors, psychological factors, social environment, and fitness behavior environment.

Application of healthcare failure mode and effect analysis in preventing nursing interruption with negative outcome in operating room / 中国实用护理杂志

Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) in reducing the incidence of nursing interruption with negative outcome in operating room, so as to maximize the smooth progress of the surgical process.Methods:This was a quasi experimental study. The gastrointestinal surgery room of Shandong Provincial Hospital Affiliated to Shandong First Medical University was selected for the study. According to the surgical sequence, 38 surgeries performed in the gastrointestinal surgery suite from August 15-30, 2021 were set as the control group, and the conventional healthcare cooperation model process was implemented; 42 surgeries performed from September 15-30, 2021 were set as the intervention group, and the operating room under the HFMEA model was implemented negative outcome care disruption event management process.A video tracking method combined with a surgical care disruption event register was used to investigate the occurrence of negative outcome care disruption events in the operating room, comparing the number, duration, source of disruption events and the incidence of near miss events in the operating room between the control group and the intervention group.Results:In the control group, there were 38 observed surgeries, 190 negative outcome care interruptions, negative outcome interruptions of (5.26 ± 1.02) min duration, and no near misses; in the intervention group, there were 42 observed surgeries, 84 negative outcome care interruptions, negative outcome interruptions of (2.06 ± 0.08) min duration, and no near misses. There were statistically significant differences in the number, duration of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 18.71, t = - 20.28; all P<0.01). There was statistically significant difference in the source of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 12.71, P<0.01). Conclusions:HFMEA model can effectively reduce the number of negative nursing interruptions in the operating room, shorten the duration of interruptions, and minimize potential safety hazards caused by nursing interruptions, which is conducive to ensuring the safety of patients.

Research on quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy / 中国实用护理杂志

Objective:To explore the effect of quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy.Methods:From June 2020 to December 2021, 175 patients who were treated CRRT in SICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as research objects. The objects were divided into control group, observation group 1 and observation group 2 according to the time of admission. Routine nursing was used in the control group (55 cases), the first cycle of plan-action-observation-reflection according to the problems of unplanned interruption was used in the observation group 1(62 cases), the quality improvement was carried out on the basis of the first cycle, and then formulated the second cycle used in the observation group 2(58 cases). The incidence of unplanned interruption of CRRT, the duration of hemofiltration line and the ability of nurses to prevent unplanned interruption of CRRT were compared before and after implementation.Results:The baseline data of CRRT patients in the three groups were comparable ( P>0.05). After cycle quality improvement, the alarm frequencies of unplanned interruption in the observation group 1 and 2 was (8.87 ± 2.66) times and (8.07 ± 2.80) times respectively, which was significant lower than the (12.04 ± 4.23) times in the control group ( t = 3.17 and 3.97, both P<0.01). The cases of coagulation filter≥Ⅱ in the observation group 1 and 2 were 25 cases and 20 cases, which were significant lower than the 32 cases in the control group ( χ2 = 3.72, 6.38, both P<0.05). The duration of blood purification line use was (15.04 ± 7.51) h and (18.16 ± 7.67) h in the observation group 1 and 2, which were significant better than the (11.75 ± 6.84) h in the control group ( t = 3.29 and 6.41, both P<0.01). The ability of nurse to prevent unplanned interruption of CRRT in the control group, the observation group 1 and 2 were (72.62 ± 6.03), (84.77 ± 5.59) and (89.64 ± 4.54), the difference was sigaificant ( F = 146.97, P<0.001). Conclusions:The application of action research study in CRRT quality improvement could reduce the occurrence of unplanned interruption of CRRT and related complications, prolong the use time of hemofiltration line, improve the therapeutic effect of CRRT, improve the quality of nursing, and is worthy of clinical promotion.

Key points to execute internal horizontal mattress suture in tissue augmentation / 口腔疾病防治

@#Ideal sutures can provide great fixation, wound closure and a stable environment for healing of the surgical site. Tension-free apposition sutures are important for tissue regeneration and could tackle insufficient amounts of soft and hard tissue, especially in missing tooth sites that require implantation. The internal horizontal mattress suture, similar to the conventional horizontal mattress suture, forms a rectangle that can be bisected by the incision with both intrusion and extrusion of the needle on each side. On the basis of the rectangle, the internal horizontal mattress suture emphasizes that the suture should be located below the incision, so the eversion of the wound margin is the highlight of this procedure. The internal horizontal mattress suture could stabilize the graft on the targeting tissue, realize the fixation of the collagen membrane, apically repositioned flap and soft tissue graft, reduce the tension on the incision, and further release the tension of the incision margin. Beyond the primary need for fixation and wound closure, internal horizontal mattress sutures can also achieve stress interruption that reduces the interference of the surrounding muscle and can better master wound tension with the assistance of interrupted sutures. Given the above advantages, horizontal internal mattress sutures have great potential in the application of implant-related regenerative surgery. In this review, according to our experience in clinical practice and the literature, we summarize the advantages of internal horizontal mattress sutures in tissue augmentation. In addition, the sites and sequence to insert the needle and the spatial relationship between the suture and incision are clarified with the rationale of the naming pattern, which is conducive to experience exchange and clinical practice.

Conocimiento de los trabajadores de salud sobre la Ley de Interrupción Voluntaria del Embarazo / Knowledge of health workers about the Voluntary Termination of Pregnancy Law

In early 2021, the theoretical and legal framework for the termination of pregnancy was modified. From August 2021 until April 2022, a survey was conducted among 310 healthcare staff from the General Hospital for Acute Care Dr. Teodoro Álvarez (HGATA, for its acronym in Spanish) and the Health & Community Action Center No. 34 (CeSAC Nº 34, for its acronym in Spanish) to assess their knowledge of the subject and their ability to provide an adequate response to patients inquiring about the procedure. Out of the total number of people surveyed, 72.9% were women, the largest age group was 26-35 years old and the most mentioned occupation was "resident" (31.3%). According to their answers, the respondents were divided into two groups: those who were informed (8.7%, n = 27) and those who were uninformed (91.3%, n = 283). 100% of the informed group were able to provide patients with a correct response while only 82,7% of the uninformed group were able to do so. The majority of the respondents (85.5%) deemed it helpful to receive training and updates on voluntary termination of pregnancy in the near future. Most of the healthcare staff from the HGATA and from the CeSAC No. 34 are unaware of the theoretical-legal framework under which the interruption of pregnancy is regulated. The uninformed presented difficulties in providing an appropriate response. These results show the formative deficit that exists in relation to the theoretical-legal framework. This information could be useful for the identification of barriers and facilitators of access to an interruption

A principios del año 2021 fue modificado el marco teórico-legal de la interrupción del embarazo. Entre los meses de agosto 2021 y abril 2022, realizamos una encuesta a 310 trabajadores del Hospital General de Agudos "Dr. Teodoro Álvarez" (HGATA) y del Centro de Salud y Acción Comunitaria Nº 34 (CeSAC Nº 34), con el objetivo de evaluar su conocimiento al respecto y su capacidad de brindar una respuesta acorde ante la demanda de dicha práctica. Del total de las personas encuestadas, el 72.9% fueron mujeres, el rango etario predominante fue el de 26-35 años y la ocupación mayoritariamente referida fue "residente" (31.3%). Entre los encuestados, definimos dos grupos: conocedores (8.7%, n = 27) y no conocedores (91.3%, n = 283). El 100% de los conocedores brindó una respuesta acorde, mientras que, con relación a los no conocedores, el 82.7% pudo hacerlo. La mayoría de los encuestados (85.5%) consideró útil recibir capacitación y actualización sobre esta temática en el futuro. Concluimos que la mayoría de los trabajadores del HGATA y del CeSAC Nº 34 desconocen el marco teórico-legal bajo el cual está reglamentada la interrupción del embarazo. Los no conocedores tuvieron dificultades para brindar una respuesta apropiada. Estos resultados muestran el déficit formativo que existe en relación con el marco teórico-legal de esta práctica. Esta información sería útil para la identificación de barreras y facilitadores de acceso a la interrupción del embarazo.

Alteraciones cardiacas y desaturación en pacientes con ventilación mecánica invasiva con sedación intravenosa continua vs interrupción diaria de sedación / Cardiac events and desaturation in patients under invasive mechanical ventilation with continuous intravenous sedation vs daily interruption of sedation / Desordens cardíacas e dessaturação em pacientes com ventilação mecânica invasiva com sedação intravenosa contínua vs interrupção diária da sedação

Resumen: Introducción: la sedación en pacientes críticos que requieren ventilación mecánica es un punto importante para brindarles seguridad y comodidad. En la actualidad el tratamiento del paciente crítico basado en la escala ABCDEF (A [assess]: valorar, prevenir y manejar el dolor. B [both]: protocolos de interrupción diaria de sedación y protocolo de respiración espontánea. C [choice]: elección de analgesia y sedación. D [delirium]: valorar, prevenir y manejar el delirio. E [early]: ejercicio y movilidad temprana. F [family]: inclusión y habilitación familiar) recomienda la interrupción diaria de la sedación y un protocolo diario de respiración espontánea, el cual ha demostrado mejoría en los resultados clínicos (días en ventilación mecánica, delirio). Éste contrasta con el manejo frecuente de sedación intravenosa continua, por lo que en este estudio se comparó la seguridad de estas dos formas de sedación (interrupción diaria versus intravenosa continua). Objetivo: comparar la incidencia de eventos cardiovasculares y desaturación entre un protocolo de interrupción diaria de sedación en pacientes con ventilación mecánica invasiva (VMI) contra sedación intravenosa continua en pacientes con ventilación mecánica invasiva. Material y métodos: tipo de estudio descriptivo comparativo, retrospectivo. Resultados: no se demostró una diferencia estadísticamente significativa en incidencia de eventos cardiacos y desaturación entre pacientes con sedación intravenosa continua y protocolo de interrupción diaria de sedación. Conclusión: la sedación intravenosa continua y el protocolo de interrupción diaria de sedación son igual de seguras en pacientes bajo VMI.

Abstract: Introduction: sedation in the critically patient requiring mechanical ventilation is an important intervention used to provide safety and comfort to the patient. Currently, the management of critically ill patients is based on the ABCDEF bundle (A [assess]: prevent and manage pain. B [both]: protocols for daily interruption of sedation and spontaneous breathing protocol. C [choice]: of analgesia and sedation. D [delirium]: assess, prevent and manage delirium. E [early]: exercise and early mobility. F [family]: inclusion and empowerment) which recommends daily interruption of sedation and a daily spontaneous breathing protocol, it has shown improvement in clinical outcomes (days on mechanical ventilation, delirium). This contrasts with the frequent management of continuous intravenous sedation. Therefore, in this study the safety of these two forms of sedation (daily interruption vs continuous intravenous) will be compared. Objective: to compare the incidence of cardiovascular events and desaturation between a protocol of daily interruption of sedation in patients with invasive mechanical ventilation versus continuous intravenous sedation in patients with invasive mechanical ventilation. Material and methods: retrospective comparative descriptive study. Results: there was no statistically significant difference in the incidence of cardiac events and desaturation between patients with continuous intravenous sedation and daily sedation interruption protocol. Conclusion: continuous intravenous sedation and daily interruption of sedation protocol are equally safe in critically ill patients.

Resumo: Introdução: a sedação em pacientes críticos que necessitam de ventilação mecânica é um ponto importante para proporcionar segurança e conforto ao paciente. Atualmente, o tratamento de pacientes críticos é baseado na escala ABCDEF (A [assess]: avaliar, prevenir e controlar a dor. B [both]: protocolos de interrupção diária da sedação e protocolo de respiração espontânea. C [choice]: escolha da analgesia e sedação. D [delirium]: avaliar, prevenir e controlar delirium. E [early]: exercício e mobilidade precoce. F [family]: inclusão e qualificação da família) recomenda interrupção diária da sedação e protocolo diário de respiração espontânea, que tem mostrado melhora nos desfechos clínicos (dias em ventilação mecânica, delirium). Isso contrasta com o manejo frequente da sedação intravenosa contínua. Portanto, neste estudo foi comparada a segurança dessas duas formas de sedação (interrupção diária vs intravenosa contínua). Objetivo: comparar a incidência de eventos cardiovasculares e dessaturação entre um protocolo diário de interrupção da sedação em pacientes com ventilação mecânica invasiva versus sedação intravenosa contínua em pacientes com ventilação mecânica invasiva. Material e métodos: tipo de estudo comparativo descritivo, retrospectivo. Resultados: não houve diferença estatisticamente significativa na incidência de eventos cardíacos e dessaturação entre pacientes com sedação intravenosa contínua e protocolo de interrupção diária da sedação. Conclusão: a sedação intravenosa contínua e o protocolo diário de interrupção da sedação são igualmente seguros em pacientes submetidos à ventilação mecânica invasiva.

Treatment-refractory heart failure as a manifestation of aortic arch atresia / Falla cardiaca refractaria a tratamiento como manifestación de atresia de arco aórtico

Abstract Background: Distal segment atresia (isthmus) is an extremely rare anatomical variant of obstructive aortic arch anomalies. Case report: We present the case of a newborn who, at 48 hours of life, presented a clinical picture of heart failure. The initial echocardiogram showed a congenital interrupted aortic arch type A, patent ductus arteriosus, and ventricular septal defect. Prostaglandins were initially indicated. Subsequently, a second echocardiogram showed the absence of ductus arteriosus; the CT angiography study confirmed this finding and revealed blood flow to the descending aorta through small intercostal blood vessels. The possibility of atresia of the distal segment (isthmus) of the aortic arch was considered and confirmed at the time of surgery. Conclusions: Aortic atresia should be considered a diagnostic possibility in the presence of type A interrupted aortic arch since the hemodynamic behavior between them is similar. Surgical medical treatment should be individualized since this condition is frequently an emergency in the neonatal period. However, this is not always the case, as other cases have been reported in schoolchildren and adults.

Resumen Introducción: La atresia de segmento distal (istmo) de arco aórtico es una variante anatómica extremadamente rara de las anomalías obstructivas del arco aórtico. Caso clínico: Se presenta el caso de un recién nacido que a las 48 horas de vida presentó un cuadro clínico de insuficiencia cardiaca. El estudio de ecocardiograma inicial mostró una anomalía congénita de interrupción de arco aórtico tipo A, conducto arterioso y comunicación interventricular. De inicio se indicaron prostaglandinas. Posteriormente, el segundo ecocardiograma mostró la ausencia del conducto arterioso; el estudio de angiotomografía confirmó este hallazgo y también reveló flujo sanguíneo hacia aorta descendente a través de pequeños vasos sanguíneos intercostales. Se consideró la posibilidad de atresia del segmento distal (istmo) de arco aórtico y se confirmó al momento del acto quirúrgico. Conclusiones: La atresia aórtica debe ser considerada como posibilidad diagnóstica en presencia de interrupción de arco aórtico tipo A, ya que el comportamiento hemodinámico entre ellos es similar. El tratamiento médico quirúrgico debe individualizarse, ya que es frecuente que sea una urgencia en el periodo neonatal. Sin embargo, no sucede así siempre, ya que se han reportado casos en escolares y adultos.

Interrupción, intermitencia y recorte de la asistencia en la escuela secundaria / Interruption, intermittence and reduction of attendance of classes in secondary school / Interrupção, intermitente e corte de frequência às aulas no ensino médio

Resumen (analítico) El propósito de este artículo es describir los procesos discontinuos que atraviesan las experiencias escolares de los/as jóvenes en relación con la asistencia escolar en una escuela secundaria técnica de la ciudad de Rosario (Argentina). Problemática que ha cobrado un renovado interés público y académico a partir de la sanción de la obligatoriedad de la educación secundaria. El estudio fue realizado desde un enfoque socioantropológico que recupera la tradición etnográfica de la antropología desde una perspectiva crítica. Se advierte que los procesos discontinuos identificados pueden favorecer la interrupción de la escolarización, es decir, el alejamiento de la escuela durante un período más o menos prolongado de tiempo. Pero, aunque no es total, esa lógica de discontinuidad también atraviesa las experiencias de quienes continúan cursando.

Abstract (analytical) The purpose of this article is to describe the discontinuous processes that affect the school experiences of young people in relation to their attendance at a technical secondary school in the city of Rosario (Argentina). This problem has gained renewed public and academic interest due to the obligation of compulsory secondary education. The study was carried out using a socio-anthropological approach, drawing on the ethnographic tradition of Anthropology based on a critical perspective. The discontinuous educational processes that were identified can contribute to the interruption of schooling, specifically when students do not attend school for a prolonged period of time. This logic of discontinuity also crosses the experiences of those who continue with their studies.

Resumo (analítico) O objetivo deste artigo é descrever os processos descontínuos que atravessam as experiências escolares dos jovens em relação à frequência escolar em uma escola técnica secundária na cidade de Rosario (Argentina). Problema que assume um renovado interesse público e académico com a sanção da obrigatoriedade do ensino secundário. O estudo foi realizado a partir de uma abordagem socioantropológica que recupera a tradição etnográfica da antropologia de uma perspectiva crítica. Notase que os processos descontínuos identificados podem acabar favorecendo a interrupção da escolaridade, ou seja, a retirada da escola por um período mais ou menos prolongado. Mas, embora não seja total, notamos que essa lógica da des-continuidade também atravessa as experiências daqueles que continuam estudando.

Lessons from the Pandemic and Healthcare Service Delivery for the Senior Citizens

Background : The healthcare delivery system is an important indicator of the quality of life in a society. The advent of the Corona Virus pandemic led to an unfortunate and unforeseen disruption in the healthcare services Globally. The older persons were impacted on multiple counts including limitations in healthcare service availability, access and social marginalization. As we gain more insight into the full impact of the Pandemic on the health quality indicators and look to resume Medical service delivery in Postpandemic times, it’s important to ensure that the older population is not neglected. Discussions : Small transitions in the delivery models but larger modifications in the mind-set may be needed to provide continued, effective and seamless healthcare services to the older Indian population. Planned interventions at each level of the system can ensure a smooth transition into the modified systems. Integration of modern telecommunication technology into the medical practice and extensive research in the area can make telemedicine a more accessible and acceptable option to the elderly patients with chronic ailments. The full extent of the impact of the Pandemic on healthcare will be revealed in the coming times requiring constant adaptation of each element of the system to cope with it.

Effects of nitroquine on the development of Plasmodium yoelii at different stages in Anopheles stephensi / 中国血吸虫病防治杂志

Objective To investigate the effects of nitroquine on the development of different stages of Plasmodium yoelii in Anopheles stephensi. Methods An. stephensi mosquitoes were fed with conventional sucrose water or sucrose water containing 100 μmol/L nitroquine one day prior to P. yoelii infection. Following starvation for 24 hours, mosquitoes were fed with the blood of Kunming mice infected with P. yoelii, and the number of oocysts was observed in the stomach of An. stephensi. After 6 days and 14 days of infection, the mosquitoes were starved for 24 hours, and then fed with conventional sucrose water or nitroquine treated sucrose water. The An. stephensi mosquitoes were starved for 24 hours 6 and 14 days post-infection with P. yoelii, and then fed with conventional sucrose water or nitroquine-containing sucrose water, the numbers of P. yoelii sporozoites were examined in the hemolymph and salivary glands of An. stephensi. Results Following exposure to nitroquine-containing sucrose water one day prior to P. yoelii infections, the number of P. yoelii oocysts was significantly lower in the An. stephensi stomach on day 7 (119.2 ± 16.1 vs. 207.3 ± 21.8; t = 3.207, P < 0.05). After conventional sucrose water was ceased for 24 hours on day 6, and An. stephensi was fed with nitroquine-containing sucrose water, the number of P. yoelii sporozoites peaked in the hemolymph on day 14 in the nitroquine treatment group (952.3 ± 22.7) and on day 12 in the sucrose water treatment group (1 287.0 ± 39.0), and there was a significant difference in the number of sporozoites in the salivary glands between the nitroquine treatment group and the sucrose water treatment group (9 467.0 ± 1 304.0 vs. 10 533.0 ± 758.7; t = 0.707, P = 0.506) on day 17. After conventional sucrose water was ceased for 24 hours on day 14, and An. stephensi was fed with nitroquine-containing sucrose water, the number of sporozoites in the salivary glands was significantly greater in the nitroquine treatment group than in the sucrose water treatment group (21 900.0 ± 2 613.0 vs. 10 533.0 ± 732.3; t = 4.188, P < 0.05). Conclusions Nitroquine treatment exhibits diverse effects the development of different stages of P. yoelii, and nitroquine treatment may reduce the transmission of P. yoelii in uninfected An. stephensi.

Analysis of influencing factors of enteral nutrition interruption in critically ill patients in general surgery department and its impact on prognosis / 中国实用护理杂志

Objective:Analysis of influencing factors of enteral nutrition interruption in critically ill patients in general surgery department and its impact on prognosis.Methods:A total of 91 cases of critically ill patients in general surgery department were selected who were admitted to the general surgery of General Hospital of Eastern Theater Command of the Chinese People′s Liberation Army in Nanjing from June 2021 to March 2022 by convenient sampling method, demographic and enteral nutrition interruption data were collected,and patients were divided into enteral nutrition interruption group and enteral nutrition uninterrupted group to investigate the analysis of the factors of affecting enteral nutrition interruption and its impact on prognosis by Logistic regression analysis.Results:There were 59 cases in the enteral nutrition interruption group and 32 cases in the enteral nutrition uninterrupted group. There were statistically significant differences in gender, analgesic and sedatives, Gastro-kinetic agent and feeding intolerance between both groups ( χ2 values were 4.51-9.97, all P<0.05). Logistic regression analysis results showed that gender ( OR=4.566, 95%CI 1.332-15.657, P<0.05), analgesic and sedatives ( OR=3.437, 95%CI 1.112-10.621, P<0.05), and feeding intolerance ( OR=4.116, 95%CI 1.257-13.479, P<0.05) were the factors of enteral nutrition interruption. There were statistically significant differences between the two groups in the number of days of enteral nutrition up to goal in 3 days, 3-7 days and 7 days, albumin,length of stay in intensive care unit, total length of stay and hospitalization expenses between both groups ( Z values were -2.80 - -0.73, all P<0.05). Conclusions:Female, analgesic and sedatives and feeding intolerance are the risk factors of enteral nutrition interruption in critically ill patients in general surgery department, and enteral nutrition interruption has an adverse impact on the prognosis.Medical staff should avoid excessive use of analgesic and sedatives, and do well in feeding tolerance management to reduce the occurrence of enteral nutrition interruption.

Clinical research on enteral nutritional interruption in critically ill children / 中国小儿急救医学

Objective:To investigate the causes of enteral nutrition interruption in pediatric intensive care unit and its relationship with prognosis.Methods:In this retrospective study, 471 critically ill children admitted to PICU of Shengjing Hospital of China Medical University from January to June 2019 were enrolled.Data were collected to describe the patient cohort(anthropometrics and diagnostic category) and nutrition practices(feeding mode, frequency, duration, and causes of feeding interruptions). The effect of nutritional interruption on the prognosis of children was statistically analyzed.Results:Ninety-four patients(20.0%) had moderate malnutrition at PICU admission, fifty-eight patients(12.3%) had severe malnutrition.The nutritional deterioration rate was 3.8%(18 cases). The average weight loss during hospitalization was -0.14 kg.A total of 181(38.4%) patients had feeding interruption(FI) during hospitalization.There were 362 episodes of FI in total, with a median of two episodes per patient.Median duration of each episode was 14.89 h. The most common cause of FI was feeding intolerance( n=158, 43.6%). There were 270 episodes of FI in children feeded with milk powder.Median energy deficits per episode was -56.53 kcal/kg.There was no significant difference regarding the duration of FI among children with different diseases, different ages and different critical scores.Children with FI had significantly longer length of hospitalization, more hospitalization costs, greater length of mechanical ventilation and greater loss of weight( P<0.05, respectively). Conclusion:Enteral nutrition interruption is very common in PICU, and FI is the main reason.Nutrition interruption will reduce energy intake, which can prolong the period of hospitalization and mechanical ventilation, increase the hospitalization cost and the weight loss.

Application of a metal occlusal surface and split framework in the treatment of a patient with mandibular distal extension absence and insufficient occlusogingival distance / 口腔疾病防治

Objective@# To investigate the effect of a metal occlusal surface and stress interruption design on minimally invasive prosthodontics for patients with distal extension absence and insufficient occlusal gingival distance.@*Methods @# We retrospectively studied the case of minimally invasive prosthodontic (Vitallium 2000) combined with a metal occlusal surface for distal extension absence in a patient with insufficient occlusal gingival distance; the stress breaking design and pressure impression technology are examined, and relevant articles are reviewd. @*Results@#The design effectively solves the problems of insufficient occlusal gingival distance, large occlusal force and easy denture fracture. Reviewing the relevant literature, stress interruption design can effectively protect abutment teeth, but the behavior of stress interruption design and stress conduction phenomena in the mouths of patients has not been reported. The T-scan test results of this study showed that before and after wearing the denture, the occlusal force distribution ratio of the patient changed from 77.5% on the left and 22.5% on the right to 61.3% on the left and 38.7% on the right. The occlusal force distribution ratio of the right dentition to the total occlusal force increased by 16.2%, and the occlusal force became better distributed. Further analysis showed that the occlusal forces on the left and right sides were nearly the same in the initial occlusion stage. As the occlusal force was further increased, the proportion of the occlusal force on the right side decreased in the middle of the occlusion stage and further decreased in the final occlusion stage until it reached a dynamic balance. The above T-scan test and literature review results suggest that this dynamic balance phenomenon of bite force is related to the stress interruption design and the stress conduction effect of the split framework.@* Conclusion @#The composite of stress interruption design and metal occlusal surface allows for minimally invasive prosthodontics for the treatment of distal extension absence in patients with insufficient occlusal gingival distance.

Chagas disease control-surveillance in the Americas: the multinational initiatives and the practical impossibility of interrupting vector-borne Trypanosoma cruzi transmission

Chagas disease (CD) still imposes a heavy burden on most Latin American countries. Vector-borne and mother-to-child transmission cause several thousand new infections per year, and at least 5 million people carry Trypanosoma cruzi. Access to diagnosis and medical care, however, is far from universal. Starting in the 1990s, CD-endemic countries and the Pan American Health Organization-World Health Organization (PAHO-WHO) launched a series of multinational initiatives for CD control-surveillance. An overview of the initiatives' aims, achievements, and challenges reveals some key common themes that we discuss here in the context of the WHO 2030 goals for CD. Transmission of T. cruzi via blood transfusion and organ transplantation is effectively under control. T. cruzi, however, is a zoonotic pathogen with 100+ vector species widely spread across the Americas; interrupting vector-borne transmission seems therefore unfeasible. Stronger surveillance systems are, and will continue to be, needed to monitor and control CD. Prevention of vertical transmission demands boosting current efforts to screen pregnant and childbearing-aged women. Finally, integral patient care is a critical unmet need in most countries. The decades-long experience of the initiatives, in sum, hints at the practical impossibility of interrupting vector-borne T. cruzi transmission in the Americas. The concept of disease control seems to provide a more realistic description of what can in effect be achieved by 2030.

Os desafios bioéticos da interrupção voluntária de hidratação e nutrição em fim de vida no ordenamento jurídico brasileiro / The Bioethical Challenges of the End-of-Life Voluntary Interruption of Hydration and Nutrition in the Brazilian Legal Syste / Los retos bioéticos de la interrupción voluntaria de hidratación y nutrición en el final de vida en el ordenamiento jurídico brasileño

Resumo: O presente artigo, por meio de pesquisa teórica de natureza exploratória, aborda como o direito de morrer é tratado no ordenamento jurídico brasileiro; assim, destaca suas principais nomenclaturas, a saber: distanásia, ortotanásia, cuidados paliativos, diretivas antecipadas de vontade e morte medicamente assistida. Destarte, o objetivo principal é tratar da interrupção voluntária de comer e beber, como possibilidade de antecipar a morte e, por conseguinte, discutir se é um meio viável ou não para se alcançar uma morte digna. Ressalta-se que o procedimento não está previsto de forma explícita nas normas brasileiras e inexistem pesquisas sobre a sua legitimidade no ordenamento pátrio como meio de se alcançar a morte digna, razão pela qual o presente artigo se justifica.

Abstract: Through theoretical research of an exploratory nature, this article addresses how the right to die is treated in the Brazilian legal system; thus, it highlights its main nomenclatures: dysthanasia, orthothanasia, palliative care, advance directives of will, and medically assisted death. The primary purpose is to deal with the voluntary interruption of eating and drinking as a possibility to hasten death and, therefore, discuss whether it is a viable means to have a dignified death. We emphasize that the procedure is not explicitly provided for in the Brazilian regulations and that there are no studies into its legitimacy as a means to achieve a dignified death in the national system, which justifies this article.

Resumen: El presente artículo, mediante investigación teórica de naturaleza exploratoria, aborda cómo el derecho de morir es tratado en el ordenamiento jurídico brasileño; así, destaca sus principales nomenclaturas: distanasia, ortotanasia, cuidados paliativos, directivas anticipadas de voluntad y muerte médicamente asistida. De este modo, el propósito principal es ocuparse de la interrupción voluntaria de comer y beber, como posibilidad de adelantar la muerte y, por ende, discutir si es un medio viable o no para lograr una muerte digna. Se resalta que el procedimiento no está previsto de forma explícita en las normas brasileñas y no existen investigaciones sobre su legitimidad en el ordenamiento patrio como medio de alcanzar la muerte digna, por lo cual el artículo se justifica.

Filtro de vena cava inferior, resultados a mediano y largo plazo / Inferior vena cava filter medium to long-term results

Resumen Introducción: El tromboembolismo pulmonar sin tratamiento, presenta un riesgo de recurrencia del 20%, con una mortalidad del 18% al 26%, en pacientes con embolia pulmonar donde esta contraindica o fracasa la anticoagulación, es necesario interrumpir parcialmente la vena cava inferior, siendo los filtros de vena cava la alternativa más utilizada. Objetivo: Analizar las variables epidemiológicas involucradas en la enfermedad tromboembólica y los resultados de la inserción del filtro de vena cava inferior. Materiales y Método: Estudio retrospectivo, observacional y descriptivo, donde se analiza la inserción sucesiva de 82 filtros de vena cava inferior, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo femenino 53,6%, edad promedio 60,4 años (rango 19-86), la principal causa para desarrollar enfermedad tromboembólica fueron las enfermedades oncológicas (56,09%), la principal vía de acceso fue la vena femoral común (69,51%), localización del filtro suprarrenal (4,87%), se obtuvo un seguimiento actualizado en el 89,02%, la supervivencia a 5 años fue de 73,17% y a 10 años de 57,32%, morbilidad en relación al procedimiento (9,75%), éxito del procedimiento (97,5%), no hubo mortalidad relacionada. Discusión: Los grandes ensayos, demuestran el beneficio de la interrupción de la vena cava inferior mediante filtros, especialmente en pacientes oncológicos, con elevado riesgo de embolia pulmonar. Conclusión: La inserción de un filtro de vena cava inferior, adecuadamente indicado, es un procedimiento mínimamente invasivo, de bajo riesgo y con excelentes resultados en la profilaxis de la embolia pulmonar.

Introduction: Pulmonary thromboembolism without treatment presents a risk of recurrence of 20%, with a mortality of 18% to 26%. In patients with pulmonary embolism, when anticoagulation therapy is contraindicated or failed, it is necessary to intervene partially the inferior vena cava on which cava vein filters are the main used alternative. Aim: Analyze the epidemiological variables involved on thromboembolic disease, and the outcomes of the inferior vena cava filter insertions. Materials and Method: Retrospective, observational and descriptive study, which analyzes the successive insertion of 82 inferior vena cava filters, over a period of 10 years (2009 to 2019), in the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Female sex 53.6%, average age 60.4 years (range 19-86), the main cause to develop thromboembolic disease were oncological diseases (56.09%); the main access path was the common femoral vein (69.51%); in a 4.87% the location of the filter was suprarenal. Complete follow-up was obtained in 89.02% of the cases, 5-year survival with 73.17% ratio and 10-years survival of 57.32%, morbidity in relation to the procedure was 9.75%; success of the procedure 97.5%; there was no mortality related. Discussion: Large studies demonstrate the benefits of interruption on the inferior vena cava through filters, especially in cancer patients with high risk of pulmonary embolism. Conclusion: The insertion of an inferior vena cava filter when indication is adequate, is a minimally invasive procedure with low risk and excellent results in the prophylaxis of pulmonary embolism.

Yasui procedure for surgical repair of interruption of aortic arch and ventricular septal defect associated with aortic stenosis or aortic atresia / 中华胸心血管外科杂志

Objective:To study the surgical results of Yasui procedure for interruption of aortic arch and ventricular septal defect(IAA/VSD) associated with aortic stenosis(AS) or aortic atresia(AA).Methods:A retrospective study was performed on all 4 children with IAA/VSD/AS(AA) that underwent a Yasui procedure from Dec 2014 to Dec 2019. Three patients had AS, and 1 patient had AA. The age was from 10 days to 25 months and the weight was from 2.7 kg to 10 kg. The type of IAA was type A in 1 and type B in 3. The diameter and Z value of the aortic annulus were 1.9-4.3 mm and -6.7--3.6. The diameter and Z value of the ascending aorta were 2.6-5.8 mm and -5.4--2.6. The mean Z value of LVEDD and LVEDS was 3.6±2.6 and 3.6±2.9 resparately.Results:All 4 patients survived after the Yasui procedure. Three patients underwent primary repair and 1 patient underwent staged repair. CPB time was 128-283 min and aortic cross-clamping time was 98-171 min. Ventilation time was 93-296 h, and ICU and hospital length of stay was 7-25 days and 18-39 days. Follow-up was complete in all patients from 8 to 92 months, and there was no late death. All the patients were in good biventricular function with NYHA grade Ⅰ in 3 and NYHA grade Ⅱ in 2 patients. No residual left ventricular outflow tract obstruction was detected.Conclusion:The Yasui procedure can be an option for patients with IAA/VSD/AS(AA) and good developed left ventricle and can achieve good early surgical results.

Application of descending aortic translocation in tracheal or bronchial stenosis due to aortic deformity / 中华胸心血管外科杂志

Objective:To investigate the efficacy of descending aortic translocation in relieving the compression of trachea or bronchus caused by aortic deformity.Methods:From January 2017 to July 2019, a total of 11 patients with distal trachea or proximal bronchial stenosis caused by aortic deformity were treated with descending aortic translocation. Cardiac CT and fiberoptic bronchoscopy were performed before surgery. The median age was 55(23-540) days, and the body weight was 4(2.1-9.0)kg. Five patients had a special type of vascular ring(left aortic arch with right descending aorta, small aortic window with funnel chest; left aortic arch with right descending aorta and right artery ligament, vagus right subclavian artery, combined with trachea, carina and left and right bronchial stenosis in 1 case; Right aortic arch with left descending aorta, combined with tracheomalacia stenosis in 1 case; Right aortic arch with left descending aorta combined with broad tracheal stenosis and left pulmonary dysplasia in 1 case) compressed tracheal or bronchial tube in 5 cases. Three patients with left main bronchus constriction after traditional arch disconnection surgery. 3 patients with left main bronchus stenosis before coarctation or interrupted aortic arch.Surgical methods: Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia.The proximal descending aorta was transected distal to the left subclavian artery, proximal sutures were performed, and the distal brought up though the transverse sinus caudad to the right pulmonary artery and tracheal carina, and anastomosed in end-to-end fashion to the ascending aorta, and simultaneous correction was performed with intracardiac malformations, such as airway plasty was performed at the same time without improvement after compression of tracheal stenosis.Results:There was no death in the whole group. Median cardiopulmonary bypass was 180(136-337)min with an median aortic cross-clamp time of 51(30-84)min; Median absence of perfusion to the descending thoracic aorta 34(21-50)min .Tracheal compression was effectively relieved in 5 patients, and airway plasty was performed simultaneously in 6 patients due to persistent tracheal softening and stenosis. All patients had resolution of symptoms.There was only one case anastomotic stenosis after descending aortic translocation.The mean follow-up was(18.0±9.4)months.Conclusion:Descending aortic translocation can effectively relieve this kind of pressure due to aortic deformity.