Pulmonary Hypertension Registry of Kerala,India (PRO-KERALA): One-year outcomes

BackgroundShort term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India.MethodsWe conducted a prospective study of 2003 patients with pulmonary hypertension, from 50 centres (PROKERALA) in Kerala, who were followed up for one year. Pulmonary hypertension (PH) was mainly diagnosed on the basis of Doppler echocardiography. The primary outcome was a composite end-point of all-cause death and hospital admission for heart failure. All cause hospitalisation events constituted the secondary outcome.ResultsMean age of study population was 56 ± 16 years. Group 1 and Group 2 PH categories constituted 21.2% and 59% of the study population, respectively. Nearly two-thirds (65%) of the study participants had functional class II symptoms. 31% of Group 1 PH patients were on specific vasodilator drugs.In total, 83 patients (4.1%) died during the one-year follow-up period. Further, 1235 re-hospitalisation events (61.7%) were reported. In the multivariate model, baseline NYHA class III/IV (OR 1.87, 95% C.I. 1.35–2.56), use of calcium channel blockers (OR 0.18, 95% C.I. 0.04–0.77), vasodilator therapy (OR 0.5, 95% C.I. 0.28–0.87) and antiplatelet agents (OR 1.80, 95% C.I. 1.29–2.51) were associated with primary composite outcome at one-year (p < 0.05).ConclusionIn the PROKERALA registry, annual mortality rate was 4%. More than half of the patients reported re-hospitalisation events on follow up. Uptake of guideline directed therapies were suboptimal in the study population. Quality improvement programmes to improve guideline directed therapy may improve clinical outcomes of PH patients in India.     

Electrolipolysis associated with aerobic activity does not reduce subcutaneous adipose tissue of the abdominal region of young women: A randomized clinical trial

ObjectiveTo analyze the effects of electrolysis, through a medium frequency current, associated to aerobic physical activity in the body composition of young women.MethodsThe study was composed of 34 sedentary women (24.35 ± 4.43 years, 71.30 ± 7.08 kg, 1.61 ± 0.06 m, 27.31 ± 1.67 kg/m2) which were evaluated for their anthropometric measures and body composition. The volunteers were randomly assigned to two group: Electrolyphysis plus Aerobic Exercise (gEEA): 17 volunteers were submitted to the application, for 60 min , of the Aussie current, followed by aerobic physical activity (77% of HRmax) on the trampoline for 40 min, through video-lessons of Jump; and Aerobic Exercise group (gEA): 17 volunteers performed only physical activity following the same parameters mentioned above. Each group performed its protocols twice weekly, for 5 weeks, totaling 10 sessions. For the data analysis, measures repeated ANOVA was performed to compare the means of the variables analyzed before and after the treatment protocols using the SPSS - 21.0 software, adopting a p ≤ 0.05.ResultsAlthough gEEA decreased suprailiac skinfold (p = 0.04), abdominal skinfold (p = 0.03) and circumference at umbilical scar (p = 0.02) in an intragroup analysis, these means differences in anthropometric measures were not important between-groups (p > 0.05). Furthermore, there were no effect of treatment on body composition (p > 0.05).ConclusionTo this studied condition, our results suggested that application of medium frequency electrolysis did not enhance the losses on anthropometric measures and body composition.     

Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review

ObjectivesTo determine which training methods positively influenced healthcare professionals’ communication skills and families’ deceased organ donation decision-making.MethodsAn integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument.ResultsTraining programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families’ perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates.ConclusionsMultiple training strategies are effective in improving interprofessional healthcare professionals’ confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences.Practice implicationsLearning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing.     

How good is the evidence that cellular senescence causes skin ageing?

Skin is the largest organ of the body with important protective functions, which become compromised with time due to both intrinsic and extrinsic ageing processes. Cellular senescence is the primary ageing process at cell level, associated with loss of proliferative capacity, mitochondrial dysfunction and significantly altered patterns of expression and secretion of bioactive molecules. Intervention experiments have proven cell senescence as a relevant cause of ageing in many organs. In case of skin, accumulation of senescence in all major compartments with ageing is well documented and might be responsible for most, if not all, the molecular changes observed during ageing. Incorporation of senescent cells into in-vitro skin models (specifically 3D full thickness models) recapitulates changes typically associated with skin ageing. However, crucial evidence is still missing. A beneficial effect of senescent cell ablation on skin ageing has so far only been shown following rather unspecific interventions or in transgenic mouse models. We conclude that evidence for cellular senescence as a relevant cause of intrinsic skin ageing is highly suggestive but not yet completely conclusive.     

尿毒清颗粒治疗慢性肾功能衰竭临床研究

目的:观察尿毒清颗粒治疗慢性肾功能衰竭(CRF)的临床疗效及其对钙磷代谢、结缔组织生长因子(CTGF)的影响。方法:选取120例CRF患者,按随机数字表法分为对照组和观察组各60例。对照组采用常规治疗,包括控制饮食、纠正酸碱、水电解质平衡;观察组在对照组的基础上加用尿毒清颗粒治疗。2组均连续治疗2个月,观察比较2组肾功能[肌酐(SCr)、血尿素氮(BUN)]、血磷(P3-)、血钙(Ca2+)、甲状旁腺激素(PTH)、CTGF指标水平变化,并评定2组临床疗效及不良反应情况。结果:观察组总有效率为80.00%,对照组为61.67%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组SCr、BUN水平均较治疗前降低(P<0.05),且观察组SCr、BUN水平均低于对照组(P<0.05)。治疗后,2组PTH、CTGF、P3-水平较治疗前降低(P<0.05),Ca2+水平较治疗前升高(P<0.05);观察组PTH、P3-、CTGF水平均低于对照组(P<0.05),Ca2+水平高于对照组(P<0.05)。观察组不良反应发生率为3.33%,对照组为16.67%,2组比较,差异有统计学意义(P<0.05)。结论:尿毒清颗粒治疗CRF临床疗效显著,可有效调节钙磷代谢、CTGF平衡,改善肾功能,且安全性较高。     

Generalized infantile myofibromatosis with visceral involvement presenting as diffuse hypopigmented macules at birth

The initial clinical presentation of infantile myofibromatosis can vary from subtle skin changes to large tumors. Here, we describe a case of congenital generalized infantile myofibromatosis which presented with diffuse hypopigmented macules, some with subtle atrophy and telangiectasia. Further workup revealed visceral involvement which led to treatment with systemic chemotherapy. Awareness of this rare clinical presentation is crucial to expedite workup and treatment given the poor prognosis in infants with visceral involvement.     

伤口组织与电刺激调控的相关性研究*

慢性伤口迁延不愈。外源性电刺激提供促进慢性伤口愈合的电流，其独特优势是使电荷调控伤口，促进伤 口愈合，具有良好的应用前景，并成为目前组织学研究者和临床医生的研究热点之一。现介绍一些常见慢性伤口 的形态学和电生理特性，主要探讨目前电荷调控伤口愈合的形态学改变、可能作用机制及其影响因素。