Phytotherapy of Vulvovaginal Candidiasis: A Narrative Review.

Vulvovaginal candidiasis (VVC) is a real gynecological problem among women of reproductive age from 15 to 49. A recent analysis showed that 75% of women will have an occurrence at least once per year, while 5% are observed to have recurrent vaginal mycosis-these patients may become unwell four or more times a year. This pathology is caused in 85-90% of cases by fungi of the Candida albicans species. It represents an intractable medical problem for female patients due to pain and pruritus. Due to the observation of an increasing number of strains resistant to standard preparations and an increase in the recurrence of this pathology when using local or oral preferential therapy, such as fluconazole, an analysis was launched to develop alternative methods of treating VVC using herbs such as dill, turmeric, and berberine. An in-depth analysis of databases that include scientific articles from recent years made it possible to draw satisfactory conclusions supporting the validity of herbal therapy for the pathology in question. Although phytotherapy has not yet been approved by the Food and Drug Administration, it appears to be a promising therapeutic solution for strains that are resistant to existing treatments. There is research currently undergoing aimed at comparing classical pharmacotherapy and herbal therapy in the treatment of vaginal candidiasis for the purpose of increasing medical competence and knowledge for the care of the health and long-term comfort of gynecological patients.

Validation of digital PCR assay for the quantification of Mycobacterium avium subsp. paratuberculosis in bovine faeces according to the ISO 20395:2019.

Paratuberculosis is an enteric disease caused by Mycobacterium avium subs. Paratuberculosis (MAP). Quantifying the load of MAP in faeces samples offers the advantage of determining the stage of infection and planning control measures. Currently, detection of MAP in faecal specimens relies on cultural assays and quantitative PCR (qPCR), but both methods have limitations such as prolonged isolation times for cultural assay and the absence of nucleic acid standards for qPCR. Digital PCR (dPCR) represents an advancement over qPCR as it allows direct quantification of nucleic acid in a sample without the need for a standard curve. The present paper reports about the validation process, following ISO 20395:2019 guidelines, of a F57 digital PCR assay for quantifying MAP cells in faecal samples. Based on our validation, the Limit Of Detection (LOD) corresponds to 7.85 104 MAP cells/g, and the Limit Of Quantification (LOQ) to 7.85 105 MAP cells, with an efficiency of recovery at LOQ estimated about 4.5%. To assess precision, we evaluated the same faecal sample extracted by two different operators at different times. The standard deviation under repeatability conditions (S Repeatability) and intersession variability conditions (S Intermediate) were calculated, resulting in values of 0.43 and 0.26, respectively. Trueness was determined at LOQ and a value ten times higher, yielding percentages of 3.35% and 5.16%, respectively. Linearity showed a R2 value of 0.998, indicating strong linear correlation. Measurement uncertainty was 26% in absolute value and 3% on a logarithmic base 10 scale. Overall, the assay exhibits good specificity and robustness. Our validation underlines the good performance of the quantification method and allow the laboratory to provide quantitative results of MAP/cells on faecal samples.

Beneficial Effects of Fermentation of Red Chili Pepper Using Lactococcus lactis subs. Cremoris RPG-HL-0136 in High-Fat Diet-Induced Obese Mice.

Red chili pepper is a beneficial natural spicy food that has antiobesity and antitype II diabetes effects, but it is not conducive to in-depth research as a dietary strategy to treat obesity. This study aims to investigate the beneficial effects of red chili pepper, fermented with a novel Lactococcus lactis subs. cremoris RPG-HL-0136. LC-MS/MS analysis is conducted to detect the content of capsaicin and dihydrocapsaicin, and no significant difference is observed between the nonfermented red chili pepper (NFP) (W/W) and the prepared L. lactis subs. cremoris RPG-HL-0136-fermented chili mixture (LFP). After establishing a high-fat diet-induced obese type II diabetic mouse model, the effects on weight gain, weight loss of liver and testicular fat, total cholesterol, triglyceride, fasting glucose, insulin, and homeostatic model assessment for insulin resistance in LFP were evaluated to be better than those in NFP following 10 weeks of interventions. All animal experiments were approved by the Institutional Animal Care and Use Committee of Xinxiang medical university. NFP and LFP could increase the expression of transient receptor potential vanilloid subfamily 1, peroxisome proliferator-activated receptor-alpha and caspase-2 in the high-fat mice. Compared with unfermented red chili pepper, the fermented red chili pepper complex significantly reduced LPS, tumor necrosis factor-alpha, and interleukin-6 in serum (P < .05). Intake of LFP significantly increased the expression of claudin-1 and occludin in the colon of the high-fat mice (P < .05), and there was no damage to the stomach and colon. This study provides scientific evidence that red chili pepper, fermented with L. lactis subs. cremoris RPG-HL-0136, may be beneficial for future treatment of obesity and accompanying diabetes. (IACUC.No.XYLL-20200019).

Hydrogen sulfide alleviates hypothyroidism-induced myocardial fibrosis in rats through stimulating autophagy and inhibiting TGF-ß1/Smad2 pathway.

Hypothyroidism alone can lead to myocardial fibrosis and result in heart failure, but traditional hormone replacement therapy does not improve the fibrotic situation. Hydrogen sulfide (H2S), a new gas signaling molecule, possesses anti-inflammatory, antioxidant, and anti-fibrotic capabilities. Whether H2S could improve hypothyroidism-induced myocardial fibrosis are not yet studied. In our study, H2S could decrease collagen deposition in the myocardial tissue of rats caused by hypothyroidism. Furthermore, in hypothyroidism-induced rats, we found that H2S could enhance cystathionine-gamma-lyase (CSE), not cystathionine ß-synthase (CBS), protein expressions. Finally, we noticed that H2S could elevate autophagy levels and inhibit the transforming growth factor-ß1 (TGF-ß1) signal transduction pathway. In conclusion, our experiments not only suggest that H2S could alleviate hypothyroidism-induced myocardial fibrosis by activating autophagy and suppressing TGF-ß1/SMAD family member 2 (Smad 2) signal transduction pathway, but also show that it can be used as a complementary treatment to conventional hormone therapy.

Anatomical characteristics of human hepatic anterior fissure vein / 中华消化外科杂志

Objective:To investigate the anatomical characteristics of human hepatic anterior fissure vein.Methods:The retrospective and descriptive study was used. A total of 22 adult cadaver specimens were collected from the Department of Human Anatomy of Harbin Medical University from March 2018 to March 2021. There were 15 males and 7 females, aged 45(range, 18?75)years. Observation indicators: (1) recognition rate of hepatic anterior fissure vein and the location of hepatic anterior fissure vein merging into hepatic vein; (2) length of hepatic anterior fissure vein and the opening diameter of hepatic anterior fissure vein merging into hepatic vein; (3) location of hepatic anterior fissure vein and the ventral hepatic vein of segment Ⅷ of liver (V8v) as well as V8v condition; (4) relationship among hepatic anterior fissure vein, anterior ventral portal vein and anterior dorsal portal vein. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range), and count data were expressed as absolute numbers or percentages. Results:(1) Recognition rate of hepatic anterior fissure vein and the location of hepatic anterior fissure vein merging into hepatic vein. The recognition rate of hepatic anterior fissure vein of 22 liver samples was 90.9% (20/22). There were 9.1%(2/22) of liver samples without hepatic anterior fissure vein. The proportions of hepatic anterior fissure vein merging into proximal middle hepatic vein and proximal right hepatic vein were 19/20 and 1/20, respectively. There was no liver sample with hepatic anterior fissure vein merging into distal middle hepatic vein and distal right hepatic vein. (2) Length of hepatic anterior fissure vein and the opening diameter of hepatic anterior fissure vein merging into hepatic vein. In the 20 liver samples with hepatic anterior fissure vein, the length of hepatic anterior fissure vein was (6.41±1.26)cm, and the opening diameter of hepatic anterior fissure vein merging into hepatic vein was (0.38±0.10)cm. (3) Location of anterior fissure vein and the V8v and V8v condition. In the 22 liver samples, there were 25 V8v branches merging into the proximal middle hepatic vein, with the V8v length as (3.83±0.36)cm and the V8v diameter as (0.16±0.08)cm. In the 17 liver samples with both hepatic anterior fissure vein and V8v, the proportion of V8v merging into hepatic anterior fissure vein and then into middle hepatic vein was 14/17, the proportion of hepatic anterior fissure vein and V8v merging into middle hepatic vein separately was 3/17, and there was no liver sample with hepatic anterior fissure vein merging into right hepatic vein and V8v merging into middle hepatic vein. (4) Relationship among hepatic anterior fissure vein, anterior ventral portal vein and anterior dorsal portal vein. Of the 20 liver samples with hepatic anterior fissure vein, the hepatic anterior fissure vein of 16 liver samples could be used as the demarcation mark of anterior ventral segment and anterior dorsal segment of hepatic right anterior region. The distance between the hepatic anterior fissure vein and anterior ventral portal vein was (1.40±0.43)cm, and that between the hepatic anterior fissure vein and anterior dorsal portal vein was (1.46±0.63)cm, showing no significant difference between them ( t=1.00, P>0.05). Conclusion:The hepatic anterior fissure vein exists in most normal adult livers, and it mostly merges into proximal middle hepatic vein. The hepatic anterior fissure vein can be identified by the condition of V8v. The hepatic anterior fissure vein can be used as the demarcation mark of anterior ventral segment and anterior dorsal segment of hepatic right anterior region.

Phytochemical Characterization of Phoradendron bollanum and Viscum album subs. austriacum as Mexican Mistletoe Plants with Antimicrobial Activity.

In Mexico, mistletoes have several applications in traditional medicine due to the great variety of compounds with biological activities that have not been characterized to date. The goals of the present study are to analyze the composition of minerals and phytochemical compounds in Mexican mistletoes Phoradendron bollanum and Viscum album subs. austriacum qualitatively and quantitatively, identify the compounds using HPLC-MS, and assess the antimicrobial potential in phytopathogenic microorganism control. Mineral content was evaluated with X-ray fluorescence. Three types of extracts were prepared: ethanol, water, and aqueous 150 mM sodium chloride solution. Characterization was carried out using qualitative tests for phytochemical compound groups, analytical methods for proteins, reducing sugars, total phenol, flavonoids quantification, and HPLC-MS for compound identification. The antimicrobial activity of mistletoe's liquid extracts was evaluated by microplate assay. K and Ca minerals were observed in both mistletoes. A qualitative test demonstrated alkaloids, carbohydrates, saponins, flavonoids, tannins, and quinones. Ethanolic extract showed flavonoids, 3845 ± 69 and 3067 ± 17.2 mg QE/g for Phoradendron bollanum and Viscum album subs. austriacum, respectively, while aqueous extracts showed a total phenol content of 65 ± 6.9 and 90 ± 1.19 mg GAE/g Phoradendron bollanum and Viscum album subs. austriacum, respectively. HPLC-MS identified largely hydroxycinnamic acids and methoxycinnamic acids. Clavibacter michiganenses was successfully inhibited by aqueous extract of both mistletoes.

Streptococcus equi subsp. zooepidemicus finding in confirmed feline infectious peritonitis cat patient.

BACKGROUND: Feline infectious peritonitis (FIP) is a fatal immune-mediated disease in cat, caused by mutated feline coronavirus (FCoV). Due to its difficulties in diagnosis, FIP is sometimes underdiagnosed. Therefore, several laboratory procedures were performed to gain high index suspicion of FIP. However, through several laboratory findings, not only FIP but also SEZ infection was confirmed in this case. CASE DESCRIPTION: A-year-old male, domestic cat was admitted to Veterinary Medicine Clinical Pathology Laboratory, Universitas Gadjah Mada, for further effusion examination due to its high suspicion of feline infectious peritonitis (FIP). Further examination using molecular and post-mortem analysis resulted on confirmed SEZ infection and FIP. This study informed the manifestation and pathological changes in patient with SEZ and FIP in the same time. CONCLUSIONS: This study showed that viral infection followed by bacterial infection could be fatal and untreatable. After these findings, clinicians may consider SEZ infection in cat with respiratory disorder followed by thoracic effusion besides FIP. Companion animal, especially outdoor-kept animal, possibly become infected from its contact to another human or animal in the environment.

Surveillance of Antibiotic Resistance Genes in Treponema Pallidum Subspecies Pallidum from Patients with Early Syphilis in France.

Benzathine penicillin G (BPG) is the reference treatment for early syphilis, but shortages have recently been reported, highlighting a need for the validation of alternative treatments. The aim of this study was to evaluate the genomic resistance of Treponema pallidum subspecies pallidum (TPA) to macrolides and doxycycline in France. Swabs from genital, anal, oral and cutaneous lesions were obtained from 146 patients with early syphilis in France. They were screened for mutations conferring resistance to macrolides and doxycycline by nested PCR and sequencing. Resistance to macrolides was detected in 85% of the isolates, but no point mutations conferring doxycycline resistance were detected. These findings confirm that, in France, resistance to macrolides is widespread. Moreover, we confirmed the absence of genomic resistance to doxycycline in the TPA strains. Therefore, doxycycline could be safely recommended as an alternative to BPG for the treatment of early syphilis.

Transcriptomic analysis of Eruca vesicaria subs. sativa lines with contrasting tolerance to polyethylene glycol-simulated drought stress.

BACKGROUND: Eruca vesicaria subsp. sativa is one of the Cruciferae species most tolerant to drought stress. In our previous study some extremely drought-tolerant/sensitive Eruca lines were obtained. However little is known about the mechanism for drought tolerance in Eruca. METHODS: In this study two E. vesicaria subs. sativa lines with contrasting drought tolerance were treated with liquid MS/PEG solution. Total RNA was isolated from 7-day old whole seedlings and then applied to Illumina sequencing platform for high-throughput transcriptional sequencing. RESULTS: KEGG pathway analysis indicated that differentially expressed genes (DEGs) involved in alpha-Linolenic acid metabolism, Tyrosine metabolism, Phenylalanine, Tyrosine and tryptophan biosynthesis, Galactose metabolism, Isoquinoline alkaloid biosynthesis, Tropane, Piperidine and pyridine alkaloid biosynthesis, Mineral absorption, were all up-regulated specifically in drought-tolerant (DT) Eruca line under drought stress, while DEGs involved in ribosome, ribosome biogenesis, Pyrimidine metabolism, RNA degradation, Glyoxylate and dicarboxylate metabolism, Aminoacyl-tRNA biosynthesis, Citrate cycle, Methane metabolism, Carbon fixation in photosynthetic organisms, were all down-regulated. 51 DEGs were found to be most significantly up-regulated (log2 ratio ≥ 8) specifically in the DT line under PEG treatment, including those for ethylene-responsive transcription factors, WRKY and bHLH transcription factors, calmodulin-binding transcription activator, cysteine-rich receptor-like protein kinase, mitogen-activated protein kinase kinase, WD repeat-containing protein, OPDA reductase, allene oxide cyclase, aquaporin, O-acyltransferase WSD1, C-5 sterol desaturase, sugar transporter ERD6-like 12, trehalose-phosphate phosphatase and galactinol synthase 4. Eight of these 51 DEGs wre enriched in 8 COG and 17 KEGG pathways. CONCLUSIONS: DEGs that were found to be most significantly up-regulated specifically in the DT line under PEG treatment, up-regulation of DEGs involved in Arginine and proline metabolism, alpha-linolenic acid metabolism and down-regulation of carbon fixation and protein synthesis might be critical for the drought tolerance in Eruca. These results will be valuable for revealing mechanism of drought tolerance in Eruca and also for genetic engineering to improve drought tolerance in crops.

Microencapsulation of Lactococcus lactis Gh1 with Gum Arabic and Synsepalum dulcificum via Spray Drying for Potential Inclusion in Functional Yogurt.

There has been an explosion of probiotic incorporated based product. However, many reports indicated that most of the probiotics have failed to survive in high quantity, which has limited their effectiveness in most functional foods. Thus, to overcome this problem, microencapsulation is considered to be a promising process. In this study, Lactococcus lactis Gh1 was encapsulated via spray-drying with gum Arabic together with Synsepalum dulcificum or commonly known as miracle fruit. It was observed that after spray-drying, high viability (~108 CFU/mL) powders containing L. lactis in combination with S. dulcificum were developed, which was then formulated into yogurt. The tolerance of encapsulated bacterial cells in simulated gastric juice at pH 1.5 was tested in an in-vitro model and the result showed that after 2 h, cell viability remained high at 1.11 × 106 CFU/mL. Incubation of encapsulated cells in the presence of 0.6% (w/v) bile salts showed it was able to survive (~104 CFU/mL) after 2 h. Microencapsulated L. lactis retained a higher viability, at ~107 CFU/mL, when incorporated into yogurt compared to non-microencapsulated cells ~105 CFU/mL. The fortification of microencapsulated and non-microencapsulated L. lactis in yogurts influenced the viable cell counts of yogurt starter cultures, Lactobacillus delbrueckii subs. bulgaricus and Streptococcus thermophilus.

Acceptability of internet-based interventions for depression in Indonesia.

BACKGROUND: In Indonesia, internet-based interventions may represent a promising strategy to reduce the mental health gap given that the level of internet usage in the country continues to increase. To check the acceptability of internet-based interventions, this study investigates factors that contribute to the use of internet-based interventions for depression in Indonesia. METHOD: The survey was conducted online and had 904 participants recruited from specific social networks on mental health and general social media (Mean age = 27.07, 50.22% females). The three dependent variables were (1) behavioral intention to start using internet-based interventions for depression, (2) preference to use it as a substitute for regular treatments and (3) preference to use it to complement regular treatments. The predictor variables included sociodemographic characteristics, perceived mental health conditions, personal situational characteristics, personal innovativeness toward online services, and depression level. RESULTS: A large majority reported to be open to using internet-based interventions for depression (73.7%), as well as to use it as a substitution (73.3%) or as a complementary (73%) to regular treatments. Personal innovativeness toward online services was the strongest significant predictor for all types of use, even when corrected for current depression level. When added to the analyses separately, depression level was the second strongest predictive factor for all dependent variables. CONCLUSION: The majority of Indonesians showed openness to use internet-based interventions for depression. To increase the adoption of internet-based interventions for depression, it is important to first promote internet usage to more people across the country, especially for those who are currently depressed.

MAP1203 Promotes Mycobacterium avium Subspecies paratuberculosis Binding and Invasion to Bovine Epithelial Cells.

Mycobacterium avium subspecies paratuberculosis (MAP) is the causative agent of Johne's disease, chronic and ultimately fatal enteritis that affects ruminant populations worldwide. One mode of MAP transmission is oral when young animals ingest bacteria from the collostrum and milk of infected dams. The exposure to raw milk has a dramatic impact on MAP, resulting in a more invasive and virulent phenotype. The MAP1203 gene is upregulated over 28-fold after exposure of the bacterium to milk. In this study, the role of MAP1203 in binding and invasion of the bovine epithelial cells was investigated. By over-expressing the native MAP1203 gene and two clones of deletion mutant in the signal sequence and of missense mutations changing the integrin domain from RGD into RDE, we demonstrate that MAP1203 plays a role in increasing binding in more than 50% and invasion in 35% of bovine MDBK epithelial cells during early phase of infection. Furthermore, results obtained suggest that MAP1203 is a surface-exposed protein in MAP and the signal sequence is required for processing and expression of functional protein on the surface of the bacterium. Using the protein pull-down assay and far-Western blot, we also demonstrate that MAP1203 interacts with the host dihydropyrimidinase-related protein 2 and glyceraldehyde 3-phosphate dehydrogenase proteins, located on the membrane of epithelial cell and involved in the remodeling of the cytoskeleton. Our data suggests that MAP1203 plays a significant role in the initiation of MAP infection of the bovine epithelium.

Fully Disposable Manufacturing Concepts for Clinical and Commercial Manufacturing and Ballroom Concepts.

The availability and use of pre-sterilized disposables has greatly changed the methods used in biopharmaceuticals development and production, particularly from mammalian cell culture. Nowadays, almost all process steps from cell expansion, fermentation, cell removal, and purification to formulation and storage of drug substances can be carried out in disposables, although there are still limitations with single-use technologies, particularly in the areas of pretesting and quality control of disposables, bag and connections standardization and qualification, extractables and leachables (E/L) validation, and dependency on individual vendors. The current status of single-use technologies is summarized for all process unit operations using a standard mAb process as an example. In addition, current pros and cons of using disposables are addressed in a comparative way, including quality control and E/L validation.The continuing progress in developing single-use technologies has an important impact on manufacturing facilities, resulting in much faster, less expensive and simpler plant design, start-up, and operation, because cell culture process steps are no longer performed in hard-piped unit operations. This leads to simpler operations in a lab-like environment. Overall it enriches the current landscape of available facilities from standard hard-piped to hard-piped/disposables hybrid to completely single-use-based production plants using the current segregation and containment concept. At the top, disposables in combination with completely and functionally closed systems facilitate a new, revolutionary design of ballroom facilities without or with much less segregation, which enables us to perform good manufacturing practice manufacturing of different products simultaneously in unclassified but controlled areas.Finally, single-use processing in lab-like shell facilities is a big enabler of transferring and establishing production in emergent countries, and this is described in more detail in 7. Graphical Abstract.

The influence of ultrasonic treatment on the growth of the strains of Salmonella enterica subs. typhimurium.

This study proposes the destruction of pathogenic bacteria with the use of ultrasound waves because the more commonly used thermal processing methods often result in lowering the nutritional value of food. The study presents the impact of ultrasound of 20, 40 and 100 kHz frequencies and the power of 10.5 W/cm2 on the growth of the strain of Salmonella enterica subs. typhimurium. The tests were carried out both in chilled and non-chilled treatment mediums, with an average bacterial population >105 and >108 CFU/cm3. The total inactivation of Salmonella spp. was observed in the tests in the low-population non-chilled treatment medium after sonication at 20 and 40 kHz for 30 min, and in high bacterial population at 20 kHz for 30 min. A reduction in the average number of bacteria was reported in the low-population non-chilled medium after 15 min of sonication at 20, 40 and 100 kHz; after 15 min of sonication at 20 and 100 kHz of the material of high bacterial population; and in the low-population chilled treatment mediums after 15 and 30 min at 20 kHz. The samples with inactivated bacteria and those with reduced bacterial counts maintained the same levels when stored at 4 °C for 24 and 48 h. Bacteria inactivation obtained after sonication lasted for up to 48 h in storage at 21 °C. For the samples with reduced bacterial counts stored at 21 °C, a rise in the average number of bacteria was recorded.

Improvement of saffron production using Curtobacterium herbarum as a bioinoculant under greenhouse conditions.

Plant Growth Promoting Rhizobacteria (PGPR) are natural soil bacteria which establish a beneficial relationship with their host. This microbiota community exists in the rhizosphere and inside plant tissues and stimulates plant growth by a variety of direct or indirect mechanisms. These bacterial plant promoters are frequently present in different environments, and are associated with many plant species, both wild and agricultural. Saffron is the dried stigmas of Crocus sativus (L.) and is the most expensive spice in the world. Remarkably, saffron cultivation and collection is carried out by hand and does not involve the use of machines. Additionally, 150 flowers are needed to produce one gram of dried stigmas. Hence, a slight increase in the size of the saffron filaments per plant would result in a significant increase in the production of this spice. In this study, we report the improved production of saffron using Curtobacterium herbarum Cs10, isolated from Crocus seronitus subs clusii, as a bioinoculant. The bacterial strain was selected owing to its multifunctional ability to produce siderophores, solubilize phosphate and to produce plant growth hormones like IAA. Furthermore, the isolate was tested on saffron producing plants under greenhouse conditions. The results indicate that Curtobacterium herbarum Cs10 improves the number of flowers and significantly enhances the length of the saffron filaments and overall saffron production compared to the control treated plants.

Competências atitudinais de estudantes de enfermagem na assistência a usuários de álcool / Habilidades de actitud de los estudiantes de enfermería en la atención de los consumidores de alcohol / Attitudinal skills of undergraduate nursing students to assist the users of alcohol

O objetivo desse estudo é apresentar um estudo teórico-reflexivo que discute a importância daformação de competências atitudinais de estudantesde Enfermagem na assistência ao usuáriode álcool. Reporta um breve, porém preocupante panorama sobre as atitudes de estudantes deenfermagem frente aos pacientes com problemas relacionados ao uso de álcool. Conclui-seque há uma urgente necessidade de refletir sobre otema em instâncias acadêmicas ecurrículos formais do profissional de Enfermagem. Considera-se imperativo que a formaçãoacadêmica prepare o graduando para a assistência neste domínio, alinhada a diretrizescalcadas em pressupostos e conhecimentos científicos atualizados, contribuindo assim para apromoção de atitudes mais apropriadas frente aos pacientes alcoolistas .

The objective of this study is to present a theoretical-reflective studythat discusses theimportance of attitudinal skills training for nursing students in assisting the user of alcohol. Itreports a brief but disturbing overview of the attitudes of nursing students towards patientswith alcohol-related problems. It concludes that itis an urgent need to consider the theme inacademic environments and formal curricula of professional nursing. It is consideredimperative that education prepares the graduate forassistance in this domain, aligned withguidelines based on assumptions and current scientific knowledge, in order to contribute tothe promotion of more appropriate attitudes towardsalcohol abusers .

Se trata de un estudio teórico-reflexivo con el objetivo de discutir la importancia de laformación de actitudes de los estudiantes de enfermería en la asistencia a los usuarios dealcohol. Se muestra una breve pero inquietante visión general de las actitudes de losestudiantes de enfermería ante los pacientes con problemas relacionados con el consumo dealcohol. Llegamos a la conclusión de que existe unaurgente necesidad de reflexionar sobre el tema en las instituciones académicas y los enfermeros en el currículo profesional. Seconsidera imprescindible que la educación prepara alos graduados para asistencia en esta áreay que está de acuerdo con las directrices basadas en supuestos y conocimientos científicosactuales, contribuyendo así a la promoción de actitudes más adecuadas hacia los pacientesalcohólicos .

A Comparison of Clinical Stability of Distal Instrument Fused Down to S1 with and without Sub-S1 Alar Screw in the Long Fusion using Segmental Pedicle Screw for Lumbar Degenerative Deformity

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to assess the stability of distal instrumentation using the bilateral S1 and sacral alar screws for the treatment of degenerative lumbar deformity. SUMMARY OF LITERATURE REVIEW: Various instrumentation methods have been introduced for increasing the strength of lumbosacral fusion. However, there are not many clinical studies that have evaluated the effectiveness of a sub-S1 alar screw for treating degenerative lumbar deformity surgery. MATERIALS AND METHODS: A total of 39 patients with degenerative lumbar deformity were treated by long fusion and we retrospectively analyzed these patients after a minimum follow-up of 1 year. All the patients underwent an operation with distal instrumentation using either bilateral S1 screws alone (the S1 group) or additional bilateral sub-S1 sacral alar screws (the SA group). There were 19 patients in the S1 group and 20 patients in the SA group. The stability of the distal instrumentation was assessed by breakage or backout of a rod and/or screws based on simple radiography. RESULTS: Instability of the distal instrumentation was detected in 6 cases (32%) in the S1 group and in 1 case (5%) in the SA group. The SA group had a more stability of the distal instrumentation than that of the S1 group with a significant difference (P0.05). CONCLUSIONS: Bilateral sacral alar screws coupled with bilateral S1 screws can provide good distal fixation for stability of the distal instrumentation when performing long fusion for treating degenerative lumbar deformity.