Mecánica y energética durante la marcha en cinta caminadora en adultos uruguayos saludables: efecto del IMC y la edad / Mechanics and energy during treadmill walking in healthy uruguayan adults: effect of BMI and age / Mecânica e energia durante a caminhada em esteira em adultos uruguaios saudáveis: efeito do IMC e Idade

La evaluación de la marcha en cinta caminadora puede resultar relevante para la toma de decisiones clínicas. No obstante, factores demográficos como la edad y el IMC pueden alterar la interpretación de los resultados. Nuestro objetivo fue obtener variables espacio- temporales, energéticas y costo de transporte durante la velocidad autoseleccionada en cinta caminadora para una muestra representativa de adultos uruguayos (n=28) y evaluar si diferentes rangos de edades e IMC pueden ser factores a tener en cuenta en pruebas clínicas donde se consideren dichas variables. Participaron 17 hombres y 11 mujeres (39,3 ± 14,8 años, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Se realizó una reconstrucción 3D del movimiento en forma sincronizada con el consumo energético. Se obtuvieron valores de referencia y luego de agrupar los participantes según su IMC y rango de edad se compararon los datos mediante test de t (p≤0.05). Los resultados revelaron discrepancias significativas en las medidas espacio-temporales y energéticas de los adultos uruguayos al caminar en cinta con respecto a la literatura. La marcha difiere entre adultos jóvenes y de mediana edad en su velocidad autoseleccionada (p=0,03), longitud de zancada (p=0,01), trabajo mecánico externo (<0,001) y recuperación de energía mecánica (0,009), destacando la importancia de considerar la edad en evaluaciones clínicas. El IMC no influyó significativamente en estas variables. Estos hallazgos subrayan la necesidad de ajustar las interpretaciones de las pruebas clínicas de la marcha sobre cinta caminadora en adultos uruguayos de mediana edad (45 a 65 años).

Treadmill gait assessment can be relevant for clinical decision-making. However, demographic factors such as age and BMI may alter result interpretation. Our aim was to obtain spatiotemporal, energetic, and cost of transport variables during self-selected treadmill walking speed for a representative sample of Uruguayan adults (n=28) and to assess if different age ranges and BMI could be factors to consider in clinical tests involving these variables. Seventeen men and eleven women participated (39.3 ± 14.8 years, 75.9 ± 12.5 kg, 1.74 ± 0.09 m, BMI 25.2 ± 4.06). A synchronized 3D motion reconstruction was performed with energy consumption. Reference values were obtained and data were compared using t-tests (p≤0.05), after grouping participants by BMI and age range. Results revealed significant discrepancies in spatiotemporal and energetic measures of Uruguayan adults walking on the treadmill, compared to the literature. Gait differed between young and middle-aged adults in their self-selected speed (p=0.03), stride length (p=0.01), external mechanical work (p<0.001), and mechanical energy recovery (0.009), emphasizing the importance of considering age in clinical evaluations. BMI did not significantly influence these variables. These findings underscore the need to adjust interpretations of treadmill gait clinical tests in middle-aged Uruguayan adults (45 to 65 years).

A avaliação da marcha na esteira pode ser relevante para a tomada de decisões clínicas. No entanto, fatores demográficos como idade e IMC podem alterar a interpretação dos resultados. Nosso objetivo foi obter variáveis espaço-temporais, energéticas e custo de transporte durante a velocidade de caminhada autoselecionada na esteira para uma amostra representativa de adultos uruguaios (n = 28) e avaliar se diferentes faixas etárias e IMC podem ser fatores a serem considerados em testes clínicos que envolvam essas variáveis. Dezessete homens e onze mulheres participaram (39,3 ± 14,8 anos, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Foi realizada uma reconstrução tridimensional do movimento sincronizada com o consumo de energia. Foram obtidos valores de referência e os dados foram comparados usando testes t (p≤0,05), após agrupar os participantes por IMC e faixa etária. Os resultados revelaram discrepâncias significativas nas medidas espaço-temporais e energéticas dos adultos uruguaios ao caminhar na esteira, em comparação com a literatura. A marcha diferiu entre adultos jovens e de meia-idade em sua velocidade autoselecionada (p=0,03), comprimento da passada (p=0,01), trabalho mecânico externo (<0,001) e recuperação de energia mecânica (0,009), destacando a importância de considerar a idade em avaliações clínicas. O IMC não influenciou significativamente essas variáveis. Esses achados destacam a necessidade de ajustar as interpretações dos testes clínicos de marcha na esteira em adultos uruguaios de meia- idade (45 a 65 anos).

Análise de forças de movimentação e características físico-químicas em alinhadores ortodônticos: avanços tecnológicos e considerações críticas / Analysis of motion forces and physicochemical characteristics in orthodontic aligners: technological advances and critical considerations

O avanço tecnológico revolucionou a prática odontológica, com os alinhadores ortodônticos emergindo como uma escolha altamente popular entre pacientes que buscam tratamentos estéticos e confortáveis. No entanto, apesar de sua crescente demanda, permanecem questões cruciais relacionadas à eficácia e análise dimensional desses dispositivos. Este artigo oferece uma análise abrangente das características químicas, físicas e mecânicas dos alinhadores ortodônticos, iluminando a influência vital do processo de termoformação e da espessura nas propriedades desses materiais. Compreender profundamente essas características é essencial para aprimorar a eficácia e a durabilidade dos alinhadores ortodônticos, contribuindo, assim, para o sucesso e a evolução dos tratamentos ortodônticos modernos. Neste estudo, exploraremos: 1) as propriedades químicas dos materiais e como elas afetam a biocompatibilidade e a resistência à degradação; 2) as características físicas, incluindo textura de superfície, transparência e sua influência na adaptação bucal e no conforto do paciente; 3) as propriedades mecânicas, como flexibilidade e rigidez, e como essas características afetam a distribuição de forças de movimentação dentária; 4) a influência do processo de termoformação na precisão e reprodutibilidade dos alinhadores, bem como sua relação com a qualidade do tratamento; 5) a análise crítica da espessura dos alinhadores e seu papel na capacidade de aplicar forças adequadas para a movimentação dentária. Ao abordar esses aspectos, este artigo visa oferecer uma visão holística das complexidades envolvidas na fabricação e uso de alinhadores ortodônticos. Esperamos que esta revisão contribua para uma compreensão mais profunda desses dispositivos e promova avanços significativos na ortodontia, beneficiando tanto os profissionais quanto os pacientes.

Technological advancement has revolutionized dental practice, with orthodontic aligners emerging as a trendy choice among patients seeking aesthetic and comfortable treatments. However, despite their growing demand, crucial questions remain regarding these devices' effectiveness and dimensional analysis. This article offers a comprehensive analysis of the chemical, physical, and mechanical characteristics of orthodontic aligners, illuminating the vital influence of the thermoforming process and thickness on the properties of these materials. Understanding these characteristics in depth is essential to improving the effectiveness and durability of orthodontic aligners, thus contributing to the success and evolution of modern orthodontic treatments. In this study, we will explore 1) the chemical properties of materials and how these properties affect biocompatibility and resistance to degradation; 2) the physical characteristics, including surface texture, transparency and their influence on oral adaptation and patient comfort; 3) mechanical properties, such as flexibility and stiffness, and how these characteristics affect the distribution of tooth movement forces; 4) the influence of the thermoforming process on the precision and reproducibility of the aligners, as well as its relationship with the quality of the treatment; 5) critical analysis of aligner thickness and its role in the ability to apply adequate forces for tooth movement. By addressing these aspects, this article aims to offer a holistic view of the complexities involved in manufacturing and using orthodontic aligners. We hope this review will contribute to a deeper understanding of these devices and promote significant advances in orthodontics, benefiting professionals and patients.

Utilidad de la tomografía de impedancia eléctrica para la programación del ventilador mecánico en paciente crítico pediátrico, una alternativa dinámica y no invasiva: revisión de dos casos clínicos / Utility of electrical impedance tomography for mechanical ventilator programming in pediatric critical patients, a dynamic and non-invasive alternative: a review of two clinical cases

La tomografía por impedancia eléctrica (TIE) es una modalidad de monitorización funcional respiratoria por imagen, no invasiva y libre de radiación, que permite visualizar en tiempo real la ventilación pulmonar regional y global en pacientes adultos y pediátricos conectados a Ventilación Mecánica (VM). OBJETIVO: Se describe la utilidad de la TIE en dos pacientes críticos pediátricos, en quienes no fue factible realizar medición de mecánica pulmonar, como herramienta para el ajuste de parámetros ventilatorios. CASOS CLÍNICOS: Se presentan dos pacientes pediátricos de 27 y 11 meses con condiciones clínicas diferentes, conectados a VM, en quienes se utilizó la TIE como método de monitoreo de la distribución pulmonar y titulación de la presión positiva al final de la espiración (PEEP) óptima, con el objetivo de obtener una ventilación pulmonar más homogénea. Se presentan mediciones funcionales con diferentes niveles de PEEP y valores de distribución en las distintas regiones de interés (ROI), además de un flujograma de situaciones en las que la TIE podría resultar útil para el ajuste ventilatorio. CONCLUSIÓN: La información funcional proporcionada por la TIE, permitió monitorizar de forma dinámica la VM y optimizar los parámetros ventilatorios, facilitando la implementación de estrategias de protección pulmonar en ambos pacientes, imposibilitados de realizar una medición estática de la mecánica respiratoria.

The Electrical Impedance Tomography (EIT) is a non-invasive and radiation-free respiratory functional imaging monitoring modality that allows real-time visualization of regional and global lung ventilation in adult and pediatric patients connected to mechanical ventilation (MV). OBJECTIVE: This paper describes the utility of EIT in two critical pediatric patients for whom measuring pulmonary mechanics was not feasible. EIT is used as a tool for adjusting ventilatory parameters. CLINICAL CASES: Two pediatric patients aged 27 and 11 months, with different clinical conditions, connected to MV are presented. EIT was used to monitor lung distribution and titrate the optimal Positive End-Expiratory Pressure (PEEP), to achieve more homogeneous lung ventilation. Functional measurements are presented with different PEEP levels and distribution values in different regions of interest (ROI), along with a flowchart illustrating situations where EIT could be useful for ventilatory adjustment. CONCLUSION: The functional information provided by EIT, allowed dynamic monitoring of MV, optimizing ventilatory parameters and facilitating the implementation of lung protective strategies in both patients, unable to undergo static respiratory mechanics measurements.

Ventilación mecánica, tiempo de hospitalización, muertes y discapacidad según las variantes del síndrome de Guillain-Barré: revisión sistemática y metaanálisis / Mechanical ventilation, hospitalization time, deaths and disability according to the variants of Guillain-Barré syndrome: systematic review and meta-analysis

RESUMEN Objetivos. Determinar el requerimiento y tiempo para ventilación mecánica y Unidad de Cuidados Intensivos (UCI), hospitalización y tiempo de hospitalización, muerte y discapacidad de las variantes axonales del Síndrome de Guillain-Barré (SGB) en comparación con la variante aguda desmielinizante en pacientes de todas las edades. Materiales y métodos. Revisión sistemática que incluyó pacientes con SGB; la exposición fueron las variantes axonales y el comparador la polineuropatía desmielinizante inflamatoria aguda (AIDP) los desenlaces fueron el requerimiento y tiempo en ventilación mecánica (VM), requerimiento y tiempo en la UCI, tiempo de hospitalización, discapacidad y muerte. Se utilizó la escala NewCasttle-Ottawa (NOS) para evaluar el riesgo de sesgo. Se realizó un metaanálisis para calcular las diferencias de medias y los riesgos relativos (RR) con sus intervalos de confianza (IC) del 95% utilizando varianzas inversas y modelos de efectos aleatorios. Resultados. De los 3116 artículos encontrados, 46 cumplieron los criterios de selección. El tiempo en VM fue 7,42 días (IC95%: 0,36 a 1,48) y el tiempo de hospitalización fue 3,11 (IC95%: 0,73 a 5,49) días en las variantes axonales. Las variantes axonales tuvieron un RR de 0,47 (IC95%: 0,24 a 0,92) para el requerimiento de VM en adultos, pero en niños fue de 1,68 (IC95%: 1,25 a 2,25). Hubo una alta heterogeneidad estadística. Conclusiones. Las variantes axonales tienen en promedio mayor tiempo de VM y de hospitalización, en total y por subgrupos. Se observó un mayor requerimiento de VM para las variantes axonales en niños; mientras que en los adultos fue menor.

ABSTRACT Objectives. To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages. Materials and methods. The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models. Results. Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity. Conclusions. Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.

Nutritional status in patients admitted to pediatric intensive care unit and its corelation with outcome

Background: The incidence of malnutrition in children admitted to pediatric intensive care unit (PICU), has always been significant. In addition, nutritional status of critically ill children deteriorates further during their PICU stay and may have negative effect on patients` outcome. This study aims to determine the critically ill children, to analyse and document its impact on outcome and to survey current nutritional practices and support in PICU.Methods: This was a prospective observational study done over a period of 10 months on critically ill patients admitted in PICU of department of pediatrics at Baroda medical college and Sir Sayajirao Gaekwad hospital, Vadodara.Results: Total of 350 patients admitted in PICU of S. S. G. hospital, Vadodara were enrolled in the study. Malnutrition was higher in age 6-60-month age group (57%) of patients admitted in PICU, 81% of severe acute malnutrition patients required mechanical ventilation and 19% required HFNC support, there was statistically significant difference in mortality (51.1%) of SAM patients as compared to normal patients.Conclusions: Malnutrition is one of the leading causes of mortality in patients admitted to PICU, with more complications with prolonged ventilator support, longer duration of stay in PICU.

Efectos del entrenamiento cluster sobre la hipertrofia muscular: una revisión sistemática / Effects of cluster training on muscle hypertrophy: a systematic review / Efeitos do treinamento em cluster na hipertrofia muscular: uma revisão sistemática

Resumen Objetivo: El objetivo de la presente revisión sistemática fue determinar los efectos del entrenamiento cluster sobre la hipertrofia muscular. Metodología: Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Pubmed, Scopus y Web of Science, utilizando las siguientes palabras clave: 'cluster training', 'rest Interval', 'rest pause', 'hypertrophy', 'resistance training' y 'cross sectional area'. Se incluyeron ensayos clínicos que utilizaron el entrenamiento cluster como intervención en personas mayores de 18 años de ambos sexos. Resultados: La revisión sistemática obtenida durante la búsqueda de las bases de datos consultadas arrojó un total de 23 artículos, potencialmente elegibles, de los cuales se tomó una muestra de 9, con los que se podían obtener resultados que respondían al objetivo de esta revisión. La cantidad de participantes de los 9 artículos elegibles fue de 172 sujetos. Los entrenamientos cluster permiten aumentar el volumen de entrenamiento y la intensidad sin provocar elevados niveles de fatiga, favoreciendo así el desarrollo de la hipertrofia muscular. Conclusiones: Los resultados de esta revisión sistemática sugieren que los entrenamientos cluster pueden ser una herramienta eficaz para el desarrollo de la hipertrofia muscular.

Abstract Objective: The aim of this systematic review was to determine the effects of cluster training on muscle hypertrophy. Methodology: A literature search was performed in the electronic databases Pubmed, Scopus and Web of Science, using the following keywords: 'cluster training', 'rest interval', 'rest pause', 'hypertrophy', 'resistance training' and 'cross sectional area'. We included clinical trials that used cluster training as an intervention in people over 18 years of age of both sexes. Results: The systematic review obtained during the search of the databases consulted yielded a total of 23 potentially eligible articles, of which a sample of 9 was taken from which results could be obtained that responded to the objective of this review. The number of participants from the 9 eligible articles was 172 subjects. Cluster workouts allow for increased training volume and intensity without causing high levels of fatigue, thus favoring the development of muscle hypertrophy. Conclusions: The results of this systematic review suggest that cluster training can be an effective tool for the development of muscle hypertrophy.

Resumo Objetivo: O objetivo desta revisão sistemática foi determinar os efeitos do treinamento em cluster na hipertrofia muscular. Metodologia: Realizou-se uma busca na literatura nas bases de dados eletrônicas Pubmed, Scopus e Web of Science, utilizando as seguintes palavras-chave: 'cluster training', 'rest interval', 'rest pause', 'hypertrophy', 'resistance training' e 'cross sectional area'. Foram incluídos ensaios clínicos que utilizaram o treinamento em cluster como intervenção em pessoas com mais de 18 anos de ambos os sexos. Resultados: A revisão sistemática realizada durante a busca nas bases de dados consultadas resultou em um total de 23 artigos potencialmente elegíveis, dos quais uma amostra de 9 foi selecionada para obter resultados que respondessem ao objetivo desta revisão. O número de participantes nos 9 artigos elegíveis foi de 172 indivíduos. Os treinos em cluster permitem um aumento no volume e na intensidade do treinamento sem causar altos níveis de fadiga, favorecendo assim o desenvolvimento da hipertrofia muscular. Conclusões: Os resultados desta revisão sistemática sugerem que o treinamento em cluster pode ser uma ferramenta eficaz para o desenvolvimento da hipertrofia muscular.

Aplicabilidade prática de parâmetros clínicos utilizados pelo enfermeiro na monitorização de pacientes em ventilação mecânica / Practical applicability of clinical parameters used by nurses in monitoring mechanically ventilated patients / Aplicabilidad práctica de parámetros clínicos utilizados por los enfermeros en el monitoreo de pacientes con ventilación mecánica

Objetivo: Descrever os parâmetros validados por enfermeiros relacionando com a sua prática assistencial na monitorização de pacientes críticos sob ventilação mecânica. Métodos: Estudo descritivo-exploratório, de abordagem quantitativa, cujos dados foram discutidos à luz da Resolução Conselho Federal de Enfermagem n. 639/2020 e de parâmetros clínicos obtidos validados por enfermeiros intensivistas. Resultados: Os parâmetros validados foram discutidos em termos de sua aplicabilidade clínica para o alcance da competência monitorização respiratória, um dos itens presentes na referida resolução como privativa do enfermeiro. Criou-se um quadro com os parâmetros gerais para a monitorização respiratória/ventilatória por enfermeiros, com alvo clínico e local de obtenção do parâmetro no ventilador mecânica, para colaborar com a sua usabilidade. Conclusão: Apresentou-se a aplicabilidade de parâmetros validados por enfermeiros na assistência aos pacientes sob ventilação mecânica. Pondera-se sua contribuição para maior qualidade na assistência, melhores desfechos clínicos, assim como, evitar complicações associadas à ventilação mecânica. (AU)

Objective: To describe the respiratory/ventilatory parameters validated by nurses relating to their care practice in critical patients on mechanical ventilation. Methods: Descriptive-exploratory study with quantitative approach, whose data were discussed based on COFEN Resolution 639/2020 and clinical parameters obtained validated by critical care nurses. Results: The validated parameters were discussed in terms of clinical applicability for achieving the competence "respiratory monitoring", one of the items present in the aforementioned resolution as private nurse care. A framework was created with the general parameters for respiratory/ventilatory monitoring by nurses, with clinical target and location of obtaining the parameter on the mechanical ventilator, to collaborate with its usability. Conclusion: The applicability of parameters validated by nurses in care of mechanically ventilated patients was presented. Its contribution to better quality care and clinical outcomes, as well as avoiding complications associated with mechanical ventilation. (AU)

Objetivo: describir los parámetros respiratorios/ventilatorios validados por enfermeros relacionando con su práctica asistencial en pacientes críticos con ventilación mecánica. Métodos: investigación descriptiva-exploratoria con abordaje cuantitativo, cuyos datos fueron discutidos en la Resolución COFEN 639/2020 y de parámetros clínicos obtenidos y validados por enfermeros intensivistas. Resultados: los parámetros validados fueron discutidos en términos de su aplicabilidad clínica para el alcance de la competencia "monitoreo respiratorio", uno de los ítems presentes en la referida resolución como exclusiva del enfermero. Se creó un cuadro con los parámetros generales para el monitoreo respiratorio/ventilatorio por enfermeros, con objetivo clínico y lugar de obtención del parámetro en el ventilador mecánico, para colaborar con su usabilidad. Conclusión: se presentó la aplicabilidad de parámetros validados por enfermeros en la asistencia a pacientes con ventilación mecánica. Se pondera su contribución para una mayor calidad en la asistencia, mejores desenlaces clínicos y, también, para evitar complicaciones asociadas con la ventilación mecánica. (AU)

Nuevos paradigmas en atrofia muscular espinal de presentación temprana: siempre es bueno recordar / New paradigms in early-onset spinal muscular atrophy: a reminder is always beneficial

La atrofia muscular espinal (AME) de presentación temprana representa la variante más severa, con una expectativa de vida generalmente no mayor a dos años sin soporte ventilatorio, debido a la insuficiencia respiratoria y la dificultad para toser. Tradicionalmente, el manejo respiratorio en muchos países ha incluido la traqueostomía para proporcionar asistencia ventilatoria invasiva de manera continua. No obstante, la introducción de medicamentos de precisión ha modificado la progresión natural de la enfermedad, evidenciando mejoras significativas en los hitos motores y beneficiando también la función respiratoria. A pesar de estas mejoras, en muchos casos sigue siendo necesaria la ventilación intermitente y/o continua, además de la facilitación de la tos. Estas necesidades pueden abordarse de forma no invasiva mediante el soporte ventilatorio no invasivo (SVN), la in-exsuflación mecánica (IEM) y el reclutamiento de volumen pulmonar (RVP), que son considerados pilares del tratamiento respiratorio en enfermedades neuromusculares. Estas estrategias promueven el desarrollo y mantenimiento de la función respiratoria, reduciendo el riesgo de exacerbaciones respiratorias que podrían llevar a intubaciones evitables. Comúnmente, los pacientes con AME experimentan intentos fallidos de extubación siguiendo protocolos tradicionales, siendo catalogados como no extubables y potenciales candidatos a traqueostomía. No obstante, existen protocolos de extubación específicos para AME que emplean SVN e IEM con un alto porcentaje de éxito, evitando traqueostomías innecesarias que pueden complicar la progresión de la enfermedad y afectar la calidad de vida. El enfoque respiratorio no invasivo es una opción de manejo segura tanto en el hospital como en el hogar, ofreciendo una mejor calidad de vida para los pacientes y sus familias.

Early-onset spinal muscular atrophy (SMA) is the most severe variant, with a life expectancy generally not exceeding two years without ventilatory support due to respiratory insufficiency and difficulty in coughing. Traditionally, respiratory management in many countries has included tracheostomy to provide continuous invasive ventilatory support. However, the introduction of precision medicine has altered the natural progression of the disease, showing significant improvements in motor milestones and also benefiting respiratory function. Despite these improvements, many cases still require intermittent and/or continuous ventilation, as well as cough facilitation. These needs can be addressed non-invasively through non-invasive ventilatory support (NIV), mechanical insufflation-exsufflation (MIE), and lung volume recruitment (LVR), which are considered the pillars of respiratory treatment in neuromuscular diseases. These strategies promote the development and maintenance of respiratory function, reducing the risk of respiratory exacerbations that could lead to avoidable intubations. Commonly, SMA patients experience failed extubation attempts following traditional protocols, being labeled as non-extubatable and potential candidates for tracheostomy. Nevertheless, there are specific extubation protocols for SMA that employ NIV and MIE with a high success rate, avoiding unnecessary tracheostomies that can complicate disease progression and impact quality of life. The non-invasive respiratory approach is a safe management option both in the hospital and at home, offering a better quality of life for patients and their families.

Cambios en Mecánica Respiratoria en Usuarios Pediátricos en Ventilación Mecánica Post Cirugía de Cardiopatía Congénita Sometidos a Kinesiología Respiratoria versus Succión Endotraqueal. Revisión Estructurada / Changes in Respiratory Mechanics in Pediatric Users on Mechanical Ventilation Post Congenital Heart Disease Surgery Undergoing Respiratory Kinesiology versus Endotracheal Suction. Structured Review

Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.

Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.

Latest research progress in airway stenosis after lung transplantation / 器官移植

With the optimization of surgical technologies and postoperative management regimens, the number of lung transplantation has been significantly increased, which has become an important treatment for patients with end-stage lung disease. However, due to the impact of comprehensive factors, such as bronchial ischemia and immunosuppression, the incidence of airway stenosis after lung transplantation is relatively high, which severely affects postoperative survival and quality of life of lung transplant recipients. In recent years, with the improvement of perioperative management, organ preservation and surgical technologies, the incidence of airway stenosis after lung transplantation has been declined, but it remains at a high level. Early diagnosis and timely intervention play a significant role in enhancing clinical prognosis of patients with airway stenosis. In this article, the general conditions, diagnosis, treatment and prevention of airway stenosis after lung transplantation were reviewed, aiming to provide reference for comprehensive management of airway stenosis after lung transplantation and improving clinical prognosis of lung transplant recipients.

Effect of printing orientation on physical and mechanical properties of 3D printing prosthodontic base resin materials / 北京大学学报(医学版)

Objective:To analyze the influence of forming direction on the surface characteristics,elastic modulus,bending strength and fracture toughness of printed parts and the relationship between forming direction and force direction,and to provide scientific basis and guidance for the clinical applica-tion of oral denture base resin materials.Methods:The 3D printing technology was used to print denture base resin samples.The shape and size of the samples referred to the current standard for testing conven-tional denture base materials.The samples used for physical performance testing were cylindrical(with a diameter of 15 mm and a thickness of 1 mm)and printed at different angles along the Z axis(0°,45°,90°).Scanning electron microscope was used to observe the microscopic topography of the different sam-ples.The color stability of different samples was observed by color stabilizer.The surface roughness of the samples was analyzed by using surface roughness tester.The Vickers hardness was measured to ana-lyze the hardness of the samples.The samples used for mechanical performance testing were rectangular(elastic modulus and bending strength:A length of 64 mm,a width of 10 mm,and a height of 3.3 mm;fracture toughness:A length of 39 mm,a width of 8 mm,and a height of 4 mm),divided into two groups:W group and H group.The W group was printed from the bottom up along the Z axis with the length × width as the bottom surface parallel to the X,Y axis plane,while the H group printed from the bottom up along the Z axis with the length × height as the bottom surface parallel to the X,Y axis plane.The forming angles of both groups were equally divided into 0°,45°,and 90°.The elastic modulus,bending strength and fracture toughness of different samples were studied through universal mechanical testing machine.SPSS 22.0 software was used for statistical analysis.Results:The microscopic topogra-phy and roughness of different samples were closely related to the printing direction,with significant differences between the 0°,45°,and 90° specimens.The 0° specimens had the smoothest surface(roughness＜1 μm).The surface of the 45 ° specimen was the roughest(roughness＞3 μm).The microhardness of the 0° sample was the best[(196.13±0.20)MPa],with a significant difference com-pared with the 90° sample[(186.62±4.81)MPa,P＜0.05].The mechanical properties of different samples were also closely related to the printing direction.The elastic modulus,bending strength,and fracture toughness of the 45° samples in the W group were the highest compared with the other groups.The results of elastic modulus showed that in the H group,the 45° specimens had the highest elastic mo-dulus,which was significantly different from the 0° and 90° specimens(P＜0.05).The elastic modulus of 0° and 45° specimens in the W group were higher than those in 90° specimens(P＜0.05).The bending strength results showed that there was no significant difference between the specimens from dif-ferent angles in the H group.The bending strength of the 90° specimens in the W group was the smallest,and there was a significant difference between 90° and the 0° and 45° specimens(P＜0.05);And the bendind strength of the 0° and 45° specimens in the W group was significantly higher than that of the 0° and 45° specimens in the H group(P＜0.05).The fracture toughness results showed that the fracture toughness of the H group specimens was lower than 1.9 MPa m1/2,which was specified in the denture base standard.The 45° samples in the W group were the highest,with significant differences compared with the 0° and 90° samples(P＜0.05).And the 90° samples of the W group specimens were lower than 1.9 MPa m1/2.And the fracture toughness of the 45° specimen in the W group was significantly higher than that of all the specimens in the H group(P＜0.05).Conclusion:The 0° samples had rela-tively better physical properties.The 45° samples had the best mechanical properties.But the fracture toughness of specimens(H group and 90° samples of W group)did not yet meet clinical requirements.That indicated that the characteristics of the 3D printing denture base resin were affected by the printing direction.Only when the performance of the printed samples in all directions met the minimum require-ments of the standard,they could be used in clinical practice.

Analysis on severity of cerebral edema and prognostic influencing factors after mechanical thrombectomy in patients with acute ischemic stroke due to anterior circulation large vessel occlusion / 重庆医学

Objective To observe the severity of cerebral edema after mechanical thrombectomy in the patients with acute ischemic stroke caused by large vessel occlusion,and to statistically analyze the related fac-tors affecting the prognosis quality of the patients,so as to guide the patients to conduct scientific interven-tion.Methods Ninety-one patients with acute ischemic stroke due to anterior circulation large vessel occlusion treated with mechanical thrombectomy in this hospital from October 2021 to October 2022 served as the ana-lytic subjects.According to the severity of brain edema,they were divided into the group Ⅰ(mild),group Ⅱ(moderate),and group Ⅲ(severe);after 12-week treatment,the improved Rankin scale was used to evaluate the prognosis.The patients with good prognosis were included in the excellent group,and the patients with poor prognosis were included in the poor group.Single factor and multifactor logistic analysis was used to ana-lyze the influencing factors and prognostic related factors of different degrees of brain edema.Results The univariate analysis showed that the percentage of patients with NIHSS score at admission ≥15,time from on-set to thrombolysis ≥6 h,history of hypertension,successful vascular recanalization and good collateral circu-lation were significantly different among the groups Ⅰ,Ⅱ and Ⅲ(P＜0.05);the multivariate logistic regres-sion analysis results showed that the NIHSS score at admission ≥15,time from onset to thrombolysis ≥6 h,and hypertension history were the risk factors leading to severe cerebral edema,while successful recanalization of blood vessels was a protective factor for cerebral edema(P＜0.05).The univariate analysis showed that in the good prognosis group the percentage of patients had good circulation of lateral branches,successful reca-nalization of blood vessels,severe cerebral edema,hypertension,time from onset to thrombolysis ≥6 h,and NIHSS score ≥15 at admission were significantly different from those in the poor prognosis group(P＜0.05).The multivariate logistic regression analysis results showed that severe cerebral edema,time from onset to thrombolysis ≥6 h and NIHSS score ≥15 at admission were the risk factors for poor prognosis,while good collateral circulation and successful recanalization of blood vessels were the positive factors for good prognosis(P＜0.05).Conclusion Mechanical thrombectomy patients with hypertension and time from onset to throm-bolysis ≥6 h and NIHSS score at admission ≥15 have more severe brain edema after treatment;severe brain edema,time from onset to thrombolysis ≥6 h,NIHSS score at admission ≥15 were the adverse factors affect-ing the prognosis of the patients with mechanical thrombectomy.

Exploration of Chinese Medicine Adjuvant Therapy for the Treatment of Difficult Withdrawal of Mechanical Ventilation Based on Pectoral Qiand Five-Viscera Correlation Theory / 广州中医药大学学报

This article takes pectoral qi as the starting point to discuss the traditional Chinese medicine(TCM)pathogenesis as well as the diagnostic and therapeutic approach to difficult withdrawal of mechanical ventilation in mechanically ventilated patients.According to the five-viscera correlation theory,it is believed that the onset of difficult withdrawal of mechanical ventilation is closely related to pectoral qi.The core pathogenesis of difficult withdrawal of mechanical ventilation is due to the insufficiency of pectoral qi and the deficiency of the lung,spleen and kidney,and the obstruction of pectoral qi and disharmony of qi and blood contribute to the key pathogenesis.Chinese medicine treatment can be carried out by the usage of Sijunzi Tang(Four Mild-Drug Decoction),Bufei Tang(Decoction for Replenishing Lung),Shenling Baizhu San(Powder of Radix Ginseng,Poria and Rhizoma Atractylodis Macrocephalae)to supplement and benefit pectoral qi,and by the utilization of Buzhong Yiqi Tang(Decoction for Tonifying Middle Energizer and Replenishing Qi),Shengxian Tang(Decoction for Lifting the Sinking of Qi in Chest),Juyuan Jian(Decoction for Replenishing Qi and Lifting the Sunken Qi)to elevate yang and lift the sinking of Qi.Moreover,herbs for regulating qi and blood should be added,and the management of the diet and daily living based on the identification of the deficiency and excess of the five viscera is stressed,so as to enhance the success rate of withdrawal of mechanical ventilation.The exploration will provide ideas for the treatment of difficult withdrawal of mechanical ventilation with the integrated Chinese and western medicine.

Progress in the application of neurosonography in monitoring the patients with acute ischemic stroke after receiving mechanical thrombectomy / 介入放射学杂志

At present,mechanical thrombectomy(MT)is the most effective means of achieving vascular recanalization in treating acute ischemic stroke(AIS)caused by large vessel occlusion.However,the monitoring and management of the patient's complications after MT has become a thorny clinical problem and it has attracted wide attention.Being of its non-invasive,flexible and quick diagnosis,and other advantages,the neurosonography has already established a perfect system in the evaluation and monitoring field of cerebral hemodynamic and structural pathology.With the innovation in technology and equipment,the guiding mode for non-invasive monitoring of intracranial pressure,autoregulation of cerebral blood flow,monitoring of intracranial hemorrhage and detection of other space-occupying lesions has been used for AIS patients,which has gradually become an important tool for the postoperative management of MT.This paper aims to make a comprehensive review about the application of neurosonography monitoring technology in AIS patients after MT,so as to provide a basis for the clinical implementation of prospective interventions,to enable AIS patients to obtain the maximum benefits from the postoperative management of MT,and to reduce the mortality of AIS patients.

Progress in the research on the influencing factors of futile recanalization after mechanical thrombectomy / 介入放射学杂志

Mechanical thrombectomy can improve the clinical outcome of patients with acute anterior circulation larger vessel occlusive stroke.However,a remarkable proportion of patients,even they have achieved a successful recanalization,still develop adverse outcomes,such as futile recanalization(FR).According to relevant literature reports,there are many factors that can affect futile recanalization.In this paper,a series of factors such as age,recanalization time,infarct volume,baseline severity,blood pressure that may affect futile recanalization of mechanical thrombectomy in patients with inanterior circulation large vessel occlusion will be comprehensively described and analyzed.(J Intervent Radiol,2024,33:321-324)

Research progress of electrical impedance tomography in positive end-expiratory pressure titration / 临床麻醉学杂志

Appropriate positive end-expiratory pressure(PEEP)level is an important component of protective lung ventilation strategy.PEEP can maintain the openness of alveoli and reduce lung collapse in-jury.Although individualized PEEP application has been increasingly recognized by clinical physicians,the optimal PEEP titration method is still controversial.Electrical impedance tomography(EIT)is a non-inva-sive and radiation-free imaging technique that can be used to dynamically assess lung function at the bedside.EIT presents changes in impedance during ventilation as dynamic images,which can reflect altera-tions in ventilation and gas distribution before and after PEEP adjustments.Therefore,EIT can be utilized to tailor individualized PEEP.This article provides a brief overview of the basic principles and monitoring pa-rameters of EIT.It elucidates the PEEP titration method under the guidance of EIT in clinical applications(PEEPEIT),aiming at enhancing the understanding of the advantages and limitations of EIT and providing reference for the setting of individualized PEEP.

Effect of sling exercise therapy on ventilator-induced diaphragm dysfunction in patients with mechanical ventilation / 中国实用护理杂志

Objective:To investigate the intervention effect of sling exercise therapy on ventilator-induced diaphragm dysfunction (VIDD) in patients with mechanical ventilation, and to provide the reference for prevention and treatment of VIDD.Methods:By a prospective randomized controlled study method, a total of 74 mechanical ventilation patients in Guangzhou Red Cross Hospital from July 2022 to July 2023 were convenient selected, they were divided into the experimental group and the control group according to the random number table method with 37 cases in each group. Both groups were given routine nursing care, the control group carried out early rehabilitation exercise, the experimental group implemented sling exercise therapy. The diaphragm function, respiratory function after the different time of intervention, and outcome events were compared between two groups.Results:Finally, the experimental group included 34 cases, 22 males and 12 females, aged (55.50 ± 12.03) years old. The control group included 36 cases, 25 males and 11 females, aged (54.78 ± 12.81) years old. There was no significant difference in the diaphragm function, respiratory function before intervention(all P>0.05). After 7 d of intervention, the diaphragmatic excursion, diaphragm thickening fraction were (1.59 ± 0.21) cm, (45.90 ± 5.20) % in the experimental group, which were higher than those in the control group (1.49 ± 0.21) cm, (42.78 ± 5.51) %, the differences were statistically significant ( t=2.13, 2.44, both P<0.05). After 5, 7 d of intervention, the rapid shallow breathing index was (81.47 ± 6.97), (77.29 ± 8.91) times. min -1.L -1 in the experimental group, which were lower than those in the control group (88.36 ± 9.04), (84.67 ± 9.64) times.min -1.L -1; after 3, 5, 7 d on intervention, the oxygenation index was (230.79 ± 44.79), (241.59 ± 23.79), (258.56 ± 23.09) mmHg(1 mmHg=0.133 kPa) in the experimental group, which were higher than those in the control group (197.25 ± 21.21), (212.72 ± 21.81), (242.75 ± 24.37) mmHg, the differences were statistically significant ( t values were 2.78-5.30, all P<0.05). The mechanical ventilator time and the length of stay in ICU were (225.29 ± 47.31) h, (12.47 ± 3.71) d in the experimental group, which were lower than those in the control group (260.53 ± 56.32) h, (14.64 ± 4.53) d, the differences were statistically significant ( t=2.83, 2.18, both P<0.05). The incidence rate of VIDD was 5.9%(2/34) in the experimental group, which was lower than that in the control group 22.2%(8/36), and the weaning success rate was 91.2%(31/34) in the experimental group, which was higher than that in the control group 72.2% (26/36), the differences were statistically significant ( χ2=4.18, 4.15, both P<0.05). Conclusions:Sling exercise therapy can effectively promote diaphragm function and respiratory function, shorten mechanical ventilator time and the length of stay in ICU of patients with mechanical ventilation, and reduce the occurrence of VIDD.

Evidence-based practice of non-invasive mechanical ventilation related pressure injury prevention guided by the integrated promoting action on research implementation in health services framework / 中国实用护理杂志

Objective:To use the best evidence of noninvasive mechanical ventilation related pressure injury prevention in the clinic guided by integrated promoting action on research implementation in health services framework (i-PARIHS) and evaluate its effect.Methods:This study is an unsynchronized before and after control study. Convenience sampling method was used to select patients receiving non-invasive mechanical ventilation from 7 wards of Beijing Hospital from October 2019 to September 2021. A total of 575 patients receiving non-invasive mechanical ventilation from October 2019 to September 2020 were included in the control group and 602 patients from October 2020 to September 2021 were included in the trial group. The control group adopted the usual care measures, and the trial group applied the prevention program for noninvasive ventilation related facial pressure injuries. The incidence of pressure injury was compared between the two groups. Nurses in 7 wards were investigated before and after the intervention program to compare the changes of knowledge level.Results:In the control group, there were 354 males, 221 females, aged (77.13 ± 14.49) years old; in the trial group there were 392 males, 210 females, aged (75.60 ± 14.27) years old. The incidence of pressure injury in the trial group was lower than the control group, but showed no significant difference ( P>0.05). In the control group, 11 cases suffered pressure injury, including 5 cases in stage 2, 6 cases in stage 3 and above. There were 9 cases in the trial group, including 8 in stage 2 and 1 in stage 3 and above. The severity of pressure injury in the trial group was lower than that in the control group, and the difference was significant ( χ2 = 3.83, 4.11, both P<0.05). The scores of the nurse′pressure injury knowledge increased from (6.77 ± 1.53) points to (7.15 ± 1.47) points, with a significant difference ( t = -2.31, P<0.05). Conclusions:Management of the prevention of noninvasive mechanical ventilation related facial pressure injury through evidence-based practice can reduce its incidence, reduce its severity, and it is beneficial to improve the clinical nurses' prevention knowledge and clinical practice level of facial pressure injury related to non-invasive mechanical ventilation.

Transcriptomic analysis of chondroprogenitors in response to flow fluid shear stress / 实用口腔医学杂志

Objective:To investigate the response of mandibular condylar chondroprogenitors to flow fluid shear stress(FFSS).Methods:Chondroprogenitors were in vitro cultured and stimulated with FFSS that can cause cell degeneration,and treated with sec-ond-generation high-throughput RNA sequencing.Differential gene expression was screened using DESeq2 software for gene ontology(GO)functional enrichment analysis,kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis and protein-protein interaction(PPI)network analysis.qRT-PCR was performed to validate the core genes screened by PPI.Results:A total of 1996 differentially expressed genes were obtained,mainly including inflammatory response and cell cycle related molecules.Among them,Actal,Atf3,Ccl2,116,Nfkbia,Ret and Vcaml were identified as the core genes.Conclusion:FFSS stimulation affects chondroprogenitor function by acting on inflammatory responses and cell cycle-related signaling pathways in chondroprogenitors.

The influence of static mechanical strain on osteoclastogenic gene expression of HPDLSCs and PPDLSCs / 实用口腔医学杂志

Objective:To explore the influence of static mechanical strain(SMS)on the osteoclastogenic gene expression of healthy periodontal ligment stem cells(HPDLSCs)and periodontitis periodontal ligment stem cells(PPDLSCs).Methods:HPDLSCs and PP-DLSCs were respectively isolated and cultured by low density in vitro.The expression of mesenchymal stem cell markers were detected by flow cytometry.Then,6％,8％,10％,12％and 14％SMS were respectively loaded to the HPDLSCs and PPDLSCs by Flexcell Tension Unit,and the expression of RANKL and C-fos was detected by real time RT-PCR.Results:Both HPDLSCs and PPDLSCs strongly expressed the mesenchymal stem cell markers STRO-1,CD146,CD90 and CD29,and higher expression of the above markers was found in HPDLSCs compared with PPDLSCs(P＜0.05).The expression of RANKL and C-fos in PPDLSCs was more obvious than that in HPDLSCs without SMS loading(P＜0.05).For HPDLSCs,the SMS of 14％induced significant up-regulation of RANKL and C-fos(P＜0.05),while no alteration was confirmed for the above osteoclastogenic genes when the SMS≤ 12％(P＞O.05).In addition,the expression of RANKL and C-fos was up-regulated significantly in PPDLSCs when the SMS≥ 10％(P＜0.05),and the expression of the above genes was not activated when the SMS ≤8％.Conclusion:HPDLSCs and PPDLSCs response differently to SMS,and ex-cessive SMS may lead to enhanced expression of osteoclastogenic genes in PPDLSCs.