ABSTRACT
The care of the child with a tracheostomy deserves special attention because of the potential devastating airway compromise and because of the need of competent care by caregivers and professionals. The recommendations on tracheostomy care published are few and approaches are inconsistent among different institutions. This clinical consensus statement aims to improve care for children with tracheostomies. A literature search was conducted, reviewed and revised by this group of experts, who concurred with these statements, based on the best evidence available and taking into account the local context.
El cuidado del niño con traqueostomía merece especial atención por el potencial riesgo para la vida que podría ocasionarse con el compromiso súbito de la vía aérea y por la necesidad de contar con cuidadores y profesionales competentes para su cuidado. Los objetivos principales de este consenso son unificar criterios, promover prácticas seguras, fomentar el uso racional de los recursos y contribuir a optimizar la calidad de vida de los niños con traqueostomías y sus familias. Para poder cumplir con estos propósitos, se realizó una búsqueda exhaustiva de la literatura científica; se seleccionó, sobre la base del análisis crítico, la mejor evidencia disponible; y se formularon, por consenso interdisciplinario, una serie de recomendaciones prácticas y adaptables al contexto local.
Subject(s)
Tracheostomy , Child , Consensus , Humans , Practice Guidelines as TopicABSTRACT
Two new saponins named avicins D (1) and G (2) were isolated from the seed pods of the desert legume plant Acacia victoriae. The structures, elucidated by 1D and 2D NMR studies and by chemical means, were characterized as acacic acid-bearing oligosaccharides at C-3 and C-28 with a side chain linked to C-21 comprised of two monoterpene carboxylic acids and a quinovose moiety. Both compounds exhibited potent cytotoxicity (apoptosis) against human T-cell leukemia (Jurkat cells) in vitro.
Subject(s)
Acacia/chemistry , Plants, Medicinal/chemistry , Saponins/isolation & purification , Terpenes/isolation & purification , Arizona , Drug Screening Assays, Antitumor , Humans , Jurkat Cells , Molecular Structure , Nuclear Magnetic Resonance, Biomolecular , Oligosaccharides/chemistry , Oligosaccharides/isolation & purification , Oligosaccharides/pharmacology , Saponins/chemistry , Saponins/pharmacology , Terpenes/chemistry , Terpenes/pharmacology , Tumor Cells, Cultured/drug effectsABSTRACT
One of the goals of cancer chemotherapy and prevention is the discovery of compounds that are relatively selective to tumor cells and, therefore, have reduced effects on normal cell growth. In previously published studies, it was shown that certain triterpene saponins (called avicins) from a desert tree, Acacia victoriae, are selectively toxic to tumor cells at very low doses (IC(50): 0.2 microg/mL for Jurkat cells). To extend this research to human clinical studies, we needed to find a reliable supply of avicins and have developed a transformed "hairy root" culture as a means of biomass production. Protocols were optimized for A. victoriae micropropagation; after a boiling water treatment, A. victoriae seeds were maintained under in vitro conditions on defined media. Embryo-axis explants from shoot tips were removed and infected with Agrobacterium rhizogenes Conn (R 1000) for hairy root induction. Plasmid integration was confirmed by PCR analysis with a primer set for a segment of the rol B gene. Culture conditions have been optimized for root biomass production, and various inducers have been investigated for enhancement of avicin production. Hairy root cultures were compared with intact pod tissue from field-grown sources for avicin content following partial purification of triterpene glycosides and HPLC separation of the secondary metabolites. From bioassays of the collected HPLC fractions, we have identified putative triterpene "metabolic clusters" with enhanced activity against tumor cells. This now provides a system for both production of clinical trial lots of active samples, but also a means to correlate structure of individual triterpene glycosides with specific cellular target activity in mammalian cells.
