Percepción del uso del humor por parte de enfermeras y pacientes en los servicios de salud mental / Perception of the use of humour by nurses and patients at Mental Health Units

Objetivo: conocer, en función de la literatura disponible, el significado del sentido del humor entre enfermeras y pacientes en el contexto de servicios de salud mental, así como determinar los factores que facilitan o dificultan el uso del sentido del humor en las unidades de salud mental. Métodos: se llevó a cabo una revisión narrativa en el periodo 2022-2023. Las búsquedas se realizaron en Pubmed, PsycINFO, LILACS y CINAHL, usando los descriptores: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, "psychiatric nursing”. Se incluyeron todo tipo de documentos que abordaran el tema según los objetivos, publicados desde 2012 hasta noviembre de 2022 en inglés, español o portugués. Se añadió un artículo traducido del coreano por su relevancia. Resultados: se incluyeron 10 manuscritos en la revisión. Los hallazgos sugieren que el sentido del humor se percibe como una herramienta esencial para fortalecer la relación entre enfermeras y pacientes en entornos psiquiátricos. No obstante, se destaca la existencia de factores que podrían conducir a un uso inapropiado del humor, llevando a la deshumanización de la atención y la posible ruptura del vínculo terapéutico. Conclusiones: es importante considerar cuidadosamente el empleo del humor en el contexto de la salud mental, para garantizar su efectividad sin comprometer la calidad asistencial. (AU)

Objective: based on the literature available, to understand the meaning of sense of humour between nurses and patients in the setting of Mental Health Units, as well as to determine the factors that facilitate its use, o make it difficult. Methods: a narrative review was conducted during the 2022-2023 period. Searches were conducted in Pubmed, PsycINFO, LILACS and CINAHL, using the descriptors: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, “psychiatric nursing”. All type of documents addressing this matter according to the objectives were included, published from 2012 until November 2022 in English, Spanish or Portuguese. An article translated from Korean was added due to its relevance. Results: ten (10) manuscripts were included in the review. Findings suggested that sense of humour was perceived as an essential tool in order to strengthen the relations between nurses and patients in psychiatric settings. However, it was highlighted that there are factors which could induce an inadequate use of humour, leading to dehumanization in care and a potential breach in the therapeutic link. Conclusions: it is important to carefully consider the use of humour in the mental health setting, in order to guarantee its effectiveness without compromising the quality of care. (AU)

Retinoic acid promotes differentiation of WiT49- but not of CCG99-11 Wilms tumour cells.

BACKGROUND: Most children with Wilms tumour are successfully treated with multidrug chemotherapy and surgery. These treatments cause severe side effects for the patients, an issue that needs to be addressed by exploring other treatment options with less or no side effects. One option is to complement current therapies with agents that could potentially induce tumour cell differentiation, for example retinoic acid (RA). AIMS: To facilitate quick assessment of an agent's effect on Wilms tumour differentiation by a rapid in vitro model system. METHODS AND RESULTS: Here WiT49 and CCG99-11 Wilms tumour cells were treated with 10 µM RA for 72 h or 9 days. Cultured cells were scraped off from Petri dishes, pelleted and embedded in paraffin in the same way as clinical tumour specimens are preserved. Cell morphology and differentiation were evaluated by analyses of haematoxylin eosin (H&E) and immunohistochemical stainings. Based on H&E, WT1 and CKAE1/3 stainings, RA treatment induced further epithelial differentiation of WiT49 cells, whereas there was no sign of induced maturation in CCG99-11 cells. Ki67 staining showed that RA inhibited cell proliferation in both cell lines. CONCLUSIONS: Our study shows that in vitro culturing of WiT49 and CCG99-11 cells, followed by pelleting and paraffin embedding of cell pellets, could aid in a quick evaluation of potential differentiating agents against Wilms tumour. In addition, our results strengthen previous results that retinoic acid could be a potential complement to regular Wilms tumour treatment.

A Review of Machine Perfusion Strategies in Liver Transplantation.

The acceptance of liver transplantation as the standard of care for end-stage liver diseases has led to a critical shortage of donor allografts. To expand the donor organ pool, many countries have liberalized the donor criteria including extended criteria donors and donation after circulatory death. These marginal livers are at a higher risk of injury when they are preserved using the standard static cold storage (SCS) preservation techniques. In recent years, research has focused on optimizing organ preservation techniques to protect these marginal livers. Machine perfusion (MP) of the expanded donor liver has witnessed considerable advancements in the last decade. Research has showed MP strategies to confer significant advantages over the SCS techniques, such as longer preservation times, viability assessment and the potential to recondition high risk allografts prior to implantation. In this review article, we address the topic of MP in liver allograft preservation, with emphasis on current trends in clinical application. We discuss the relevant clinical trials related to the techniques of hypothermic MP, normothermic MP, hypothermic oxygenated MP, and controlled oxygenated rewarming. We also discuss the potential applications of ex vivo therapeutics which may be relevant in the future to further optimize the allograft prior to transplantation.

Temporal characteristics of agarwood formation in Aquilaria sinensis after applying whole-tree agarwood-inducing technique.

Objective: Agarwood-a resinous wood produced by Aquilaria plants in response to injury or artificial induction-is a valuable medicinal and fragrance resource. Whole-Tree Agarwood-Inducing Technique (Agar-WIT) has been widely used to produce agarwood. However, the time-dependent characteristics of agarwood formation induced by Agar-WIT are yet to be clarified. To promote technologically efficient utilization and upgradation of Agar-WIT, the dynamic process and mechanism of agarwood formation were analyzed for one year. Methods: Agarwood formation percentage, barrier layer microscopic properties, extract levels, compound level, and characteristic chromatograms of agarwood were examined by referring to the Chinese Pharmacopeia (2020 version). Results: Agar-WIT could maintain a high percentage of agarwood formation over one year compared with that of healthy plants. Alcohol-soluble extract and agarotetrol levels showed fluctuating cyclic changes with peaks occurring first during the fifth and sixth months, and subsequently in the 11th month. Aquilaria trees subjected to Agar-WIT treatment for 1-12 months showed significant characteristics of a dynamic agarwood formation process. The barrier layer began to appear in the fourth month after treatment. Alcohol-soluble extractive levels in agarwood formed in the second month, and thereafter, exceeded 10.0%, and agarotetrol in agarwood produced after four months or later, exceeded 0.10%. Conclusion: According to the Chinese Pharmacopoeia, alcohol-soluble extractive levels in agarwood should not be less than 10.0% and agarotetrol level should exceed 0.10%. After four months of Agar-WIT treatment, the formed agarwood theoretically met these standards and was suitable for developed and utilization. However, the optimal harvest time was found to be the 11th month, followed by the sixth month after Agar-WIT treatment. Therefore, Agar-WIT resulted in swift agarwood formation and stable accumulation of alcohol-soluble extracts and agarotetrol. Thus, this method is efficient for large-scale cultivation of Aquilaria sinensis to produce agarwood and provide raw materials for the agarwood medicinal industry.

Promoção do conforto da criança e do adolescente: O humor enquanto intervenção de enfermagem / Promoting comfort for children and adolescents: Humor as a nursing intervention

As situações de doença e/ou hospitalização de crianças, adolescentes e famílias são consideradas experiências adversas, já que ao vivenciá-las são despoletadas emoções de tonalidade negativa nestes mesmos clientes, associadas principalmente ao ambiente hospitalar desconhecido, aos procedimentos assustadores e potencialmente dolorosos e à separação do seu contexto familiar habitual. Todas estas condicionantes traduzem um estado de conforto comprometido no cliente pediátrico que as experiencia. O presente relatório de estágio tem como foco agregador o humor terapêutico, enquanto intervenção autónoma e independente de enfermagem por pretender responder a um objetivo terapêutico concreto, já que apresenta sustentação teórica e científica válida no campo disciplinar da enfermagem. O humor pode ser considerado uma estratégia de coping útil e eficaz para uma adaptação e gestão emocional da criança, adolescente e família à situação de doença e/ou hospitalização, tendo em vista a promoção do seu conforto. Ao utilizar o humor, os profissionais de enfermagem promovem o brincar, despoletam o riso e o sorriso e dão asas à criatividade e imaginação dos clientes pediátricos num ambiente onde por vezes são descurados. Este percurso formativo objetiva o desenvolvimento e aquisição de competências comuns de Enfermeiro Especialista e de Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica. Para isso foi adotada uma metodologia de aprendizagem experiencial e de prática reflexiva, baseada em evidência científica. O referencial teórico utilizado para a sustentação da problemática escolhida foi a Teoria de Conforto de Katharine Kolcaba, tendo ainda sido consideradas duas filosofias chave da enfermagem pediátrica: os Cuidados Centrados na Família e os Cuidados não Traumáticos. Das atividades desenvolvidas neste percurso de estágios posso destacar a elaboração do "Kit sem dor Humoroso" com a utilização de materiais lúdicos e humorosos na promoção do conforto da criança em situação de doença e/ou hospitalização, a elaboração de um estudo de caso a uma criança com dor presente e conforto comprometido e a realização de diversas sessões de formação em contexto de trabalho.

The illness situations and/or hospitalization in children, adolescents and families are considered adverse experiences, due to the fact that living them brings up to the surface negative emotions on these clients, mainly associated to the unknown hospital environment, scary and potentially painful procedures, and also due to separation from their regular home environment. All these conditionings lead to a compromise comfort state in the pediatric client who experiences such situations. This intership report focuses on therapeutic humor as an autonomous and independent nursing intervention, as it aims to respond to a concrete therapeutic objective, since it shows valid theorical and scientific support in the disciplinar field of nursing. Humor can be considered a useful and effective coping strategy for the adaptation and emotional management of the child, adolescent and family to the illness situation and/or hospitalization in order to promote their comfort. By using humor, nursing professionals are promoting playing, bringing up the laughter and smiles, and giving room to creativity and imagination amongst the pediatric clients in an environment which these are sometimes neglected This learning path aims the developing and acquisition of common skills of specialist nurse and specialist nurse in pediatrics health. Therefore, a methodology of experimental learning was adopted, as well as a reflected practice, based on scientific evidence. From the review taken, the model chosen to support the underline topic was "The Theory of Comfort" from Katharine Kolkaba. Also considered two main pediatric nursing core beliefs: family-centered care and non traumatic care. From all activities developed on this clinical journey, I would evoke the elaboration of a "Humorous no pain kit", that uses ludic and humorous materials to promote child's comfort in an illness and/or hospitalization situation, a case study of a child with checked pain and compromised comfort, as well as several training education sessions on clinical set.

Prioritizing direct heart procurement in organ donors after circulatory death does not jeopardize lung transplant outcomes.

Background: Controlled donation after circulatory death (cDCD) has become a standard in liver, kidney, and lung transplantation (LTx). Based on recent innovations in ex vivo heart preservation, heart transplant centers have started to accept cDCD heart allografts. Because the heart has very limited tolerance to warm ischemia, changes to the cDCD organ procurement procedures are needed. These changes entail delayed ventilation and prolonged warm ischemia for the lungs. Whether this negatively impacts lung allograft function is unclear. Methods: A retrospective analysis of cDCD lungs transplanted between 2012 and February 2022 at the Medical University of Vienna was performed. The heart + lung group consisted of cases in which the heart was procured by a cardiac team for subsequent normothermic ex vivo perfusion. A control group (lung group) was formed by cases where only the lungs were explanted. In heart + lung group cases, the heart procurement team placed cannulas after circulatory death and a hands-off time, collected donor blood for ex vivo perfusion, and performed rapid organ perfusion with Custodiol solution, after which the heart was explanted. Up to this point, the lung procurement team did not interfere. No concurrent lung ventilation or pulmonary artery perfusion was performed. After the cardiac procurement team left the table, ventilation was initiated, and lung perfusion was performed directly through both stumps of the pulmonary arteries using 2 large-bore Foley catheters. This study analyzed procedural explant times, postoperative outcomes, primary graft dysfunction (PGD), duration of mechanical ventilation, length of intensive care unit (ICU) stay, and early survival after LTx. Results: A total of 56 cDCD lungs were transplanted during the study period. In 7 cases (12.5%), the heart was also procured (heart + lung group); in 49 cases (87.5%), only the lungs were explanted (lung group). Basic donor parameters were comparable in the 2 groups. The median times from circulatory arrest to lung perfusion (24 minutes vs 13.5 minutes; P = .002) and from skin incision to lung perfusion (14 minutes vs 5 minutes; P = .005) were significantly longer for the heart + lung procedures. However, this did not affect post-transplantation PGD grade at 0 hours (P = .851), 24 hours (P = .856), 48 hours (P = .929), and 72 hours (P = .874). At 72 hours after transplantation, none of the lungs in the heart + lung group but 1 lung (2.2%) in lung group was in PGD 3. The median duration of mechanical ventilation (50 hours vs 41 hours; P = .801), length of ICU stay (8 days vs 6 days; P = .951), and total length of hospital stay (27 days vs 25 days; P = .814) were also comparable in the 2 groups. In-hospital mortality occurred in only 1 patient of the lung group (2.2%). Conclusions: Although prioritized cDCD heart explantation is associated with delayed ventilation and significantly longer warm ischemic time to the lungs, post-LTx outcomes within the first year are unchanged. Prioritizing heart perfusion and explantation in the setting of cDCD procurement can be considered acceptable.

Observational Study of Early Outcomes in Single-Vessel and Multiple-Vessel Renal Allograft.

Introduction End-stage renal disease (ESRD) is a global problem with a similar worldwide need for renal replacement therapy. However, the availability of transplant organs remains a challenge. Therefore, we conducted this study to measure early outcomes (up to one month) of renal allograft functions after renal transplant by assessing graft vascularity. We also measured the changes in serum creatinine and hemoglobin levels in single- and multiple-vessel renal allograft recipients. Methods We conducted an observational study of 108 renal allograft patients for two years. The study included all renal allograft recipients during the study period. The study excluded patients with a history of renal transplant, patients on antithrombotic therapy, a donor with previous surgery of graft kidney, and patients with anatomic abnormalities. Eighty-five patients were in the single-vessel group, and 23 were in the multiple-vessel group. Donors and recipients received standard pretransplant workup, including donor CT angiography and human leukocyte antigen crossmatching. We performed laparoscopic donor nephrectomies for all participants and perfused all renal arteries separately with Renograph solution (Claris Lifesciences, North Brunswick, NJ). A renal transplant was done in the right or left iliac fossa, noting warm and cold ischemia times. In single-vessel recipients, we anastomosed the renal artery to the external iliac artery (EIA), the renal vein to the external iliac vein (EIV), and the ureter to the bladder via a modified Lich-Gregoir technique. In multiple-vessel recipients, we performed bench anastomosis to make a single vessel, or we anastomosed vessels separately to the EIA, EIV, or the inferior epigastric artery for patients with a second small renal artery. We measured postoperative serum creatinine and hemoglobin levels for one month. In addition, we assessed graft vascularity with ultrasound-guided (USG) Doppler in the first postoperative week. We used IBM SPSS Statistics for Windows, version 21.0. (IBM Corp., Armonk, NY) for all data analyses. Results Warm ischemia time (WIT) was longer in multiple-vessel patients than in single-vessel patients, but the difference was insignificant (p=0.054). Cold ischemia time (CIT) was significantly longer in the multiple-vessel group than in the single-vessel group (p=0.048). We found no significant difference in serum creatinine or hemoglobin levels between groups during the study period. Perigraft collection occurred in three single-vessel patients and decreased vascularity in two multiple-vessel patients, according to USG Doppler. Conclusions We conducted this study to measure early outcomes of renal allograft functions after renal transplant by assessing graft vascularity, serum creatinine, and hemoglobin levels in single- and multiple-vessel renal allograft patients. According to our results, renal transplantation is not inferior in multiple-vessel allograft patients. We found no significant difference in serum creatinine levels one month postoperatively. Using multiple-vessel donors helps increase the limited donor pool, which is ultimately better for managing ESRD patients.

Nuclear movement in growing Arabidopsis root hairs involves both actin filaments and microtubules.

Nuclear migration during growth and development is a conserved phenomenon among many eukaryotic species. In Arabidopsis, movement of the nucleus is important for root hair growth, but the detailed mechanism behind this movement is not well known. Previous studies in different cell types have reported that the myosin XI-I motor protein is responsible for this nuclear movement by attaching to the nuclear transmembrane protein complex WIT1/WIT2. Here, we analyzed nuclear movement in growing root hairs of wild-type, myosin xi-i, and wit1 wit2 Arabidopsis lines in the presence of actin and microtubule-disrupting inhibitors to determine the individual effects of actin filaments and microtubules on nuclear movement. We discovered that forward nuclear movement during root hair growth can occur in the absence of myosin XI-I, suggesting the presence of an alternative actin-based mechanism that mediates rapid nuclear displacements. By quantifying nuclear movements with high temporal resolution during the initial phase of inhibitor treatment, we determined that microtubules work to dampen erratic nuclear movements during root hair growth. We also observed microtubule-dependent backwards nuclear movement when actin filaments were impaired in the absence of myosin XI-I, indicating the presence of complex interactions between the cytoskeletal arrays during nuclear movements in growing root hairs.

Efficacy of laughter-inducing interventions in patients with somatic or mental health problems: A systematic review and meta-analysis of randomized-controlled trials.

BACKGROUND AND PURPOSE: Laughter-inducing interventions hold promise as affordable and easy to implement treatments for a range of ailments. The aim of this study was to build on meta-analytic evidence for the efficacy of such interventions in treating somatic or mental health patients. METHODS: Studies eligible for the meta-analysis were identified by a comprehensive literature search in MEDLINE, CENTRAL, Web of Science, and PsycINFO and by a manual search (date of last search 22/06/2021). All randomized controlled trials comparing spontaneous laughter or simulated laughter to treatment as usual, no treatment/waitlist, or attention control groups were included. There were no language or date restrictions. Separate random-effects meta-analyses were conducted for mental health, physiological, and physical health outcomes. Hedges' g is reported as the standardized mean difference estimate. The study was registered on PROSPERO (#CRD42019139299). RESULTS: Forty-five studies comprising 2,547 randomized participants were included. Laughter-inducing interventions showed significant positive effects on mental health (31 studies, 1,543 patients, g = 0.74, 95% CI [0.48; 1.00], I2 = 81%), physiological (14 studies, 761 patients, g = 0.61 [0.20; 1.03], I2 = 86%), and physical health outcomes (21 studies, 1,105 patients, g = 0.59 [0.30; 0.88], I2 = 80%). Only one study reported adverse events, which were mild in nature. CONCLUSION: Laughter-inducing interventions can have beneficial effects on a variety of health-related outcomes including mental health, physical health, and physiological parameters. Future research should focus on examining differential intervention effects and mechanisms of action.

Do Natural Portosystemic Shunts Need to Be Compulsorily Ligated in Living Donor Liver Transplantation?

BACKGROUND: Natural portosystemic shunt ligation practices in liver transplant vary widely across transplant centres and are frequently undertaken to prevent the serious consequence of portal steal phenomenon. No concrete indications have so far been convincingly identified for their management in living donor liver transplant. METHODS: We retrospectively studied the outcome of 89 cirrhotic patients who either did (n = 63) or did not (n = 25) undergo shunt ligation during living donor liver transplantation between 2017 and 2020. RESULTS: The incidence of early allograft dysfunction/nonfunction (P = 1.0) and portal venous complications (P = 0.555) were similar between the two groups. Although overall complications, biliary complications, and the composite of Grade III and IV complications were significantly higher in the nonligated group (P = 0.015, 0.052 and 0.035), 1- year graft and patient survival were comparable between them (P = 0.524). CONCLUSION: We conclude that shunt ligation in living donor liver transplantation may not always be necessary if adequate portal flow, good vascular reconstruction, and good graft quality have been ensured.

Technical characteristics and quality of grafts in liver procurement from brain-dead donors: A single-center study in Vietnamese population.

INTRODUCTION: Donor liver graft quality plays an especially important role that contributes to the success of organ transplantation. Almost all local and international authors are interested in the techniques and results of transplantation, however, in Vietnam, there have not been any studies that report the results of liver procurement from brain-dead donors from a technical perspective as well as the morphology and function of the transplanted organ. MATERIALS AND METHOD: This study is descriptive cross-section study with analysis of retrospective occurrences of a series of cases of liver procurement from brain-dead donors from March 2010 to March 2020. All cases were proceeded the multiple organ procurement with warm liver dissection and in vivo cannulation and perfusion. RESULTS: The average age of brain-dead donors was 29.7 ± 10.7 (18-69), 92.16% of the harvested organs were of good quality macroscopically; and the rate of anatomical modification was 33.3% that occurred mostly in the left hepatic artery (LHA). Technically, warm dissection was proceeded in majority of cases (98,0%), the graft implantation was performed by this technique with mean cold ischemia time (CIT) of 190,0 ± 100,5 min and WIT of 74,0 ± 39,2 s. There were no complications relating to graft injuries occurring during procurement and no primary liver failure, good results accounted for 94.1% of the total number of transplants postoperatively. CONCLUSION: Multiple organ procurement with warm liver dissection and in vivo cannulation and perfusion was a safe technique and may be effective by avoiding any donor's damages in cold-phase dissection.

Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India.

BACKGROUND: With ageing population and higher prevalence of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in older patients, more and more living donor liver transplants (LDLTs) are being considered in this group of patients as eligibility for deceased donor liver transplant is restricted to those aged 65 years and younger. However, the short- and long-term outcomes of this group have not been reported from India, which does not have a robust national health scheme. The aim of this study was to provide guidelines for transplant in this group. METHODS: All patients aged 60 years and older (group 1) who underwent LDLT in our centre between January 2006 and December 2017 were studied. A propensity score-matched group in 1:2 ratio was created with comparable sex and Model for End-Stage Liver Disease score (group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1-, 3- and 5-year survival. RESULTS: Group 1 consisted of 207 patients, and group 2 had 414 patients. The number of patients in group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting for 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC, and they had a higher 30-day mortality due to cardiorespiratory complications. Although 1- and 3-year survival was similar, the 5-year survival was significantly lower in group 1. CONCLUSION: Five-year survival was lower in the elderly group due to cardiorespiratory complications and recurrence of HCC. Outcomes in the elderly group can be improved with better patient selection and preventing HCC recurrence.

Sentido de humor, bem-estar subjetivo e competências de coping desportivo em atletas / Humor, subjective well-being and sports coping skills in athletes / Humor, bienestar subjetivo y habilidades de afrontamiento deportivo en atletas

Resumo Introdução: O sentido de humor tem sido estudado como uma estratégia para lidar com adversidade, sendo considerado um importante mecanismo de coping, utilizado em situações de stress. Objetivo: Verificar a relação entre sentido de humor, o bem-estar subjetivo e as competências de coping desportivo num grupo de atletas. Métodos: Estudo transversal e correlacional, realizado numa amostra não probabilística de 47 atletas de triatlo e mountain Bike. Os instrumentos utilizados foram: Athletic Coping Skills Inventory-28, Multidimensional Sense of Humor Scale (versão portuguesa), Escala de Felicidade Subjectiva de Lyubomirsky e Lepper e Positive and Negative Affect Schedule. Utilizou-se estatística descritiva e coeficiente de correlação de Spearman e o nível de significância adotado foi p<0,05. Resultados: Produção e Uso Social do Humor e Apreciação do Humor estão positivamente correlacionadas com a Felicidade Subjetiva. O Humor Adaptativo e a Produção e Uso Social do Humor estão positivamente correlacionados com a dimensão Afetividade Positiva e com a dimensão Rendimento sob Pressão da Escala de Competências de Coping Desportivo. Conclusões: O papel do sentido de humor e suas dimensões no bem-estar subjetivo dos atletas e nas suas competências psicológicas, deve ser considerado na conceção de programas de promoção de estratégias de coping e de saúde mental em atletas.

Abstract Background: Sense of humor has been studied as a strategy to deal with adversity and is considered an important coping mechanism used in stressful situations. Aim: To verify the relationship between humor, subjective well-being and sports coping skills in a group of athletes. Methods: Cross-sectional and correlational study. Performed on a non-probabilistic sample of 47 triathlon and mountain bike athletes. The instruments used were: Athletic Coping Skills Inventory-28, Multidimensional Sense of Humor Scale (portuguese version), Lyubomirsky and Lepper's subjective happiness scale and Positive and Negative Affect Schedule. Descriptive statistics and Spearman's correlation coefficient were used, and the significance level adopted was p<0.05. Results: Production and Social Use of Humor and Humor Appreciation are positively correlated with subjective happiness. Adaptive Humor and Production and Social Use of Humor are positively correlated with the positive affect dimension and the performance under pressure dimension of the Athletic Coping Skills Inventory. Conclusions: The role of humor and its dimensions in the subjective well-being of athletes and their psychological skills should be considered in the design of programs to promote coping strategies and mental health in athletes.

Resumen Contexto: El sentido del humor se ha estudiado como una estrategia para enfrentar la adversidad y se considera un mecanismo de afrontamiento importante utilizado en situaciones estresantes. Objetivo(s): Verificar la relación entre el humor, el bienestar subjetivo y las habilidades de afrontamiento deportivo en un grupo de atletas. Metodología: Estudio transversal y correlacional. Realizado en una muestra no probabilística de 47 atletas de triatlón y bicicleta de montaña. Los instrumentos utilizados fueron: Athletic Coping Skills Inventory-28, Multidimensional Sense of Humor Scale (versión portuguesa), Escala de Felicidad Subjetiva de Lyubomirsky y Lepper y Positive and Negative Affect Schedule. Se utilizaron estadísticas descriptivas y el coeficiente de correlación de Spearman y el nivel de significancia adoptado fue p<0.05. Resultados: La producción y el uso social del humor y la apreciación del humor están positivamente correlacionados con la Felicidad Subjetiva. El Humor Adaptativo y la Producción y el Uso Social del Humor se correlacionan positivamente con la dimensión de Afecto Positivo y la dimensión de Rendimiento sobre Presión de la Escala de Habilidades de Afrontamiento Deportivo. Conclusiones: El papel del humor y sus dimensiones en el bienestar subjetivo de los atletas y sus competencias psicológicas deben considerarse en el diseño de programas para promover estrategias de afrontamiento y salud mental en los atletas.

The effect of leucaena hay as a source of effective fibre and nutrients in diets with forage palm for finishing sheep in semi-arid regions.

The present study was conducted to evaluate the intake, digestibility and nitrogen balance of diets for finishing sheep, containing leucaena hay as a source of effective fibre and forage palm. Twenty-one male sheep were used in a randomized block design with three treatments, represented by total diets, where the forage was leucaena hay and forage palm in natura in proportions 350:650, 450:550 and 550:450 g/kg respectively. For the pH and NH3 -N in the ruminal fluid, and urea in the blood serum, plots split in time were adopted. Dry matter and nutrient digestibility, and the nitrogen balance were not influenced (p > .05) by the diets. The neutral detergent fibre digestibility decreased (p < .05) as the proportions of leucaena hay in the diets increased. The pH and NH3 -N were suitable for ruminal fermentation, and blood urea was maintained under normal physiological conditions for sheep. Combining 350 to 550 g/kg of leucaena hay with 450 to 650 g/kg of forage palm in total diets with a forage:concentrate ratio of 60:40 in late-maturing sheep meets the nutritional requirements for daily gain 200 g, characterizing leucaena hay as important source of effective fibre and nutrients in diets.

Resident-Driven Wellness Initiatives Improve Resident Wellness and Perception of Work Environment.

BACKGROUND: Resident burnout is associated with increased adverse patient events and increased incidence of resident depression and suicide when compared to the general population. We hypothesized that resident-driven assessment and implementation of wellness measures would allow implementation of desired interventions and facilitate improvement in wellness. METHODS: A wellness intervention team was established to address resident wellness and job satisfaction. A needs assessment to determine desired interventions as well as a three-part anonymous 5-point Likert scale survey was developed and distributed to general surgery residents. Following implementation of three measures, a postintervention survey was administered at 6 and 15 mo to the same cohort. Analysis of variance test was used to evaluate for significant difference between preintervention and postintervention surveys. RESULTS: Three interventions were implemented: two protected weekday personal days per year, modernization of resident workspace, and additional meal funds. There were statistically significant changes in perceptions of wellness opportunities (3.14 versus 3.88 and 3.7; P < 0.05), time for wellness (2.53 versus 3.42 and 3.2; P < 0.05), work/life balance satisfaction (2.86 versus 3.71 and 3.41; P < 0.05), and improved quality of life (2.67 versus 3.3 and 3.0; P < 0.05) in both 6-mo and 15-mo postintervention responses. CONCLUSIONS: Implementation of resident-selected wellness measures was found to influence overall resident satisfaction and improved perception of the working environment. Several scores of wellness items showed sustained improvement at 15 mo. These results suggest that resident-driven wellness interventions can positively affect working conditions for residents.

Content Determination of Related Substances in Belinostat by HPLC / 中国药房

OBJECTIVE：To establish the method for the con tent determination of related substances in belinstat. METHODS ： HPLC method was adopted and the principal component self-control comparison method with correction factor was used to calculate the contents of related substances. The determination was performed on ODS-AM column with 1.02％ potassium dihydrogen phosphate buffer （pH value adjusted to 3.5 with phosphoric acid ）-acetonitrile（85∶15，V/V）as mobile phase A ，1.02％ potassium dihydrogen phosphate buffer （pH value adjusted to 3.5 with phosphoric acid ）-acetonitrile（30 ∶ 70，V/V）as mobile phase B （gradient elution ），at the flow rate of 1.0 mL/min. The column temperature was set at 30 ℃，and the detection wavelength was 220 nm. The sample size was 10 μL. RESULTS：The linear ranges of belinstat and impurities A ，D，F，G，H were 0.113-1.693， 0.050-1.496，0.117-1.750，0.098-1.471，0.120-1.799，0.100-1.506 μ g/mL（r≥0.999 7）. The correction factors of the last 5 impurities were 1.0，1.0，1.2，1.5，1.0；the detection limits were 0.250，0.590，0.490，0.600，0.500 ng，respectively. The quantification limits were 0.500，1.170，0.980，1.200，1.000 ng，respectively. The recoveries were 90.18％-111.48％（RSD＝ 1.52％-4.78％，n＝9）. RSDs of stability （100 h）and precision tests were no more than 16％，and the durability was good. Impurities A ，D and H were detected in 3 batches of belinlestat ，the contents were 0.030％-0.038％，0.019％-0.022％ and 0.012％-0.013％，respectively. The contents of other maximum monomer impurities were 0.012％-0.013％ and the total impurities were 0.075％-0.084％. Impurities B ，C，F，G were not detected. CONCLUSIONS ：The method for the content determination of related substances in belinstat has been successfully established ，and the method is accurate and specific.

Organ Procurement in the Brain Dead Donors Without In Vivo Cold Perfusion: A Novel Technique.

INTRODUCTION: We describe our technique of ex vivo organ perfusion and procurement in donation after deceased brain death (DBD) donors. MATERIAL AND METHODS: This technique comprises warm dissection of liver, kidneys, and heart, in hemodynamically stable DBD donors and perfusing them ex vivo. The cardiac and abdominal dissection can take place simultaneously. As a precaution, the iliac arteries and the abdominal aorta are dissected and kept ready for rapid cannulation and perfusion, should the donor become unstable at any stage.The liver dissection is in principle similar to living donor hepatectomy, where portal dissection is combined with supra and infrahepatic caval dissection to completely mobilize liver to allow it to be removed and perfused ex vivo. The renal dissection is done after hepatic dissection is complete. The sequence of recovery of organ was modified where kidneys were procured first followed by hepatic and cardiac procurement simultaneously. RESULTS: Twelve multivisceral (liver and kidneys in all and heart in four) procurements have been performed. The average perfusion fluid volume for liver was 3.4 L. All recipients had uneventful postoperative course. CONCLUSION: Our technique has not affected recipient outcomes and with benefits of less use of preservation solution, shortening bench surgery time, and decreasing the propensity of procurement injuries by avoiding cold-phase dissection.

Characteristics and Outcomes of Kidney Transplant Recipients Requiring High-Acuity Care After Transplant Surgery: A 10-Year Single-Center Study.

OBJECTIVE: To study the characteristics and outcomes of a cohort of kidney transplant recipients who required high-acuity care after transplant surgery. PATIENTS AND METHODS: All adult (aged ≥18 years) solitary kidney transplant recipients from January 1, 2007, through December 31, 2016, were screened and those who required high-acuity care within the same hospitalization were enrolled. Patient demographic and clinical data were collected from the departmental database and electronic DataMart. RESULTS: Of 1525 patients, 266 (17.4%) required high-acuity care after the kidney transplant operation: 166 (62.4%) directly from the operating room and 100 (37.6%) after an interval during the same hospitalization. Overall, 2 main indications were hypotension (n=87; 32.7%) and cardiac rhythm disturbances (n=83; 31.2%). Recipients in the direct admission group had higher medium body mass index (31.0 [interquartile range, 26.6-36.0] vs 28.0 [interquartile range, 24.3-32.4] kg/m2; P<.001) and were more likely to have undergone a concomitant procedure with the transplant surgery. Overall, in-hospital mortality was 1.9% (n=5). CONCLUSION: In contemporary practice, patients with higher body mass index are more likely to require high-acuity care immediately after kidney transplant surgery. The most common reasons are hypotension and cardiac rhythm disorders. The overall intensive care unit mortality rate of these patients is low. However, these patients are at risk for graft loss and death in the long term compared with patients who do not require intensive care unit care after transplant surgery.

Effect of Donor Hepatic Steatosis on Ischemia Reperfusion Injury in Liver Transplant Recipient.

INTRODUCTION: Ischemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI. AIM: The aim of this study was to determine the effect of type and grade of donor liver steatosis on the occurrence and severity of IRI in LT recipients. METHODS: This was an observational study conducted at a single center over a period of 37 months from July 2013 to August 2016. Liver biopsy was performed twice, initially at the time of procurement before graft perfusion for steatosis assessment. Steatosis was classified as microsteatosis (MiS) or macrosteatosis (MaS) with mild, moderate, or severe grade. Second biopsy for IRI assessment was taken before skin closure in death donor LT (DDLT) and at the time of transaminitis in postoperative period (<72 hrs) in living donor LT (LDLT). IRI was graded as per neutrophil infiltrate, apoptosis, and hepatocyte cell dropout. Prevalence of IRI and association steatosis was studied along with other factors. RESULTS: Among 53 subjects, 35 were DDLTs and 18 were LDLTs. All live donor grafts were restricted to <15% MaS and the deceased liver grafts had different type and degree of steatosis. In DDLTs, the association between occurrence of IRI and MaS was not statistically significant (P = 0.201). In DDLTs, the mild steatosis was not significantly associated with IRI. Death donor and ischemic time were significantly associated with IRI. Child's stage and MELD scores, gender, and age were not associated with risk of IRI. Severity of IRI is significantly associated with 3-month mortality (P = 0.001). CONCLUSION: In patients with mild steatosis, IRI does not correlate with steatosis. However, more patients with moderate and severe steatosis are needed to define the relationship of the two in this group of patients.

Inflexibility of beliefs and jumping to conclusions in active schizophrenia.

Jumping to conclusions (JTC) has been questioned as sufficient cognitive bias for the onset, maintenance, and severity of delusions compared to the bias of inflexibility of beliefs. The WIT (What is this?) test was designed to evaluate JTC and its capacity for classifying participants into a group of patients with active schizophrenia and a comparison group. It was also attempted to determine whether the presence/absence of answer choices, considered a measure of induced inflexibility of beliefs, influences decision-making and is related to the tendency to repeat the first decision, or spontaneous inflexibility of beliefs. The sample was made up of 160 participants, 80 patients with schizophrenia diagnosed at hospital admission and 80 healthy controls. The Beads Task and the WIT test were administered. The WIT classified the participants reasonably well (82.7%) compared to the Beads Task (86.3%). The presence of answer choices favored JTC (d = 0.33), decreasing the number of lines necessary to make a decision (d = 1.78), and influencing keeping to the original answer (d = 1.36), in interaction with the group (d = 0.42). The WIT test overcame some limitations of the Beads Task. The presence/absence of answer choices influenced decision-making and how thinking was flexibilized, more clearly in the case of controls.