Articles de revues sur le sujet « 163-Ho »

Abstract Several experiments on the study of the electron neutrino mass are based on high-statistics measurements of the energy spectrum following electron capture of the radionuclide 163Ho. They rely on the availability of large, radiochemically pure samples of 163Ho. Here, we describe the production, separation, characterization, and sample production within the Electron Capture in Holmium-163 (ECHo) project. 163Ho has been produced by thermal neutron activation of enriched, prepurified 162Er targets in the high flux reactor of the Institut Laue-Langevin, Grenoble, France, in irradiations lasting up to 54 days. Irradiated targets were chemically processed by means of extraction chromatography, which allowed separating the formed Ho from the 162Er target-material and from the main byproducts 170Tm and 171Tm, which are co-produced in GBq amounts. Decontamination factors of >500 for Er and of >105 for Tm and yields of 3.6·1016 and 1.2·1018 atoms of 163Ho were obtained, corresponding to a recovery yield of 95 % of Ho in the chemical separation. The Ho-fraction was characterized by means of γ-ray spectrometry, Inductively-Coupled-Plasma Mass Spectrometry (ICP-MS), Resonance Ionization Mass Spectrometry (RIMS) and Neutron Activation Analysis (NAA). In this process, the thermal neutron capture cross section of 163Ho was measured to σHo-163 to Ho-164m= (23±3) b and σHo-163 to Ho-164g= (156±9) b for the formation of the two isomers of 164Ho. Specific samples were produced for further purification by mass separation to isolate 163Ho from the Ho-isotope mixture, as needed for obtaining the energy spectrum within ECHo. The partial efficiency for this second separation step is (32±5) %.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) are common in hospitals and nursing homes. Infection prevention efforts reduced MRSA BSI in hospitals but the trend in nursing homes is not well described. In addition, the contribution of methicillin sensitive S. aureus (MSSA) to the total burden of invasive S. aureus (iSA) in nursing homes remains unknown. Methods: As part of the CDC Emerging Infections Program, we conduct population-based surveillance for iSA infections in Monroe County, New York. Case patients were county residents with S. aureus isolated from a sterile site. Our analysis was limited to data from 2009–2018 for MRSA and 2015–2018 for MSSA and to cases classified as hospital-onset (HO, positive culture ≥3 calendar days after admission) or nursing home-onset (NHO, positive culture in nursing homes or within 3 days of hospital admission from a nursing home). Risk factors for iSA BSI in nursing homes were compared using the χ2 and Student t tests in SAS version 9.4 software. Results: During 2009–2014, 664 MRSA cases occurred and 427 (64%) were BSIs. Of these, 228 (53%) were NHO and 199 (47%) were HO. The BSI incidence per 100,000 population of NHO cases declined from 7.9 in 2009 to 2.8 in 2014, mirroring the decline in HO incidence from 8.7 in 2009 to 3.1 in 2014 (Fig. 1). During 2015–2018, 203 MRSA cases (163 BSIs, 80%) and 235 MSSA cases (163 BSIs, 69%) occurred. Of the 163 MRSA BSIs, 94 (58%) were NHO and 69 (42%) were HO, whereas of the 235 MSSA BSIs, only 56 (34%) were NHO and 107 (66%) were HO. MRSA BSI incidence per 100,000 population in both settings plateaued during 2015–2018 (Fig. 1) and MSSA NHO BSI incidence was lower than HO (1.9 NHO vs 3.6 HO). The total iSA BSI incidence was similar in both settings (5.9 vs 5.0 per 100,000 population in HO and NHO, respectively). NHO MSSA and MRSA cases have similar risk factors for BSI; 45 (30%) had decubitus ulcers, 34 (23%) were on chronic dialysis, 41 (27%) had a CVC in place within 2 days of BSI onset, and 63% had prior healthcare exposures. Most of these developed within 4 weeks of hospital discharge (Fig. 2). Conclusions: The incidence of MRSA BSI in nursing homes has declined since 2009 but plateaued starting in 2015. Compared to MRSA, MSSA caused fewer BSIs in nursing homes; however, iSA risk factors, including previous healthcare exposure, were similar. Continued study is needed to identify interventions effective against all iSA infections in nursing homes.Funding: NoneDisclosures: None

17050 Background: Better Q and outcomes in HO practice are associated with com with national treatment guidelines (TG). Institution of an O specific electronic medical record (EMR) within a community HO specialty practice allowed analysis of com with TG as well use of high cost treatments (HCT) data from an HMO population in a multi site HO practice are presented. Methods: HO physicians agreed to treat patients (pts) using common EMR, TG and regular treatment (tx) reviews. EMR data over 18 months for the HMO population was reviewed for diagnosis, stage, and tx. This was compared to TG of NCCN. A panel of high cost therapies (HCT) was identified by the HMO medical director, and pt treatment com with TG was tabulated. Non-com was further evaluated as acceptable alternative practice (acc) by NCCN description, recommended (rec) by academic specialist consultation or not appropriate by TG (non-app). Results: Between 1/1/04 and 6/31/05, the HMO had ∼75,000 covered lives at risk. 1210 evaluable HO pts were treated by 5 oncologists. 163 pts had benign H diagnoses (dx), 155 had malignant H dx, and 892 had solid tumor dx (breast 373, colorectal 76, lung 63, prostate 28, ovary 15). Of pt with cancer (ca), 49 had active ca but no rx, 639 had ca in complete remission and had no tx, and 256 had active ca and received tx. 102 had clinical diagnosis but incomplete evaluations, none received tx. Of HMO chosen HCT, Rituximab was given to 25 pt, and all rx was com to TG. Bevacizumab was given to 14 pt and was com in 11, acc in 1, and non-com/acc in 2. Trastuzumab was given to 8 pt, and was com in 4, acc in 3, and rec in 1 pt. IVIG was com in 1 and rec in 1 pt. Of a total 49 HCT, 8 were non-com with TG (16%), but only 2 were non-com, non-acc, and non-rec (4%). Both were associated with 1 new physician whose performance improved after pre tx review of HCT by a senior physician prior to pt tx. Conclusions: Ongoing review and feedback to physicians using EMR and national TG allows objective monitoring and improvement of Q in HO practice. Issues of concern, such as HCT, can also be detailed. Payors and practices can consider using such methods and data to negotiate fair payment for Q care. . No significant financial relationships to disclose.

Abstrak Kecemasan akan datangnya masa menopause umumnya terjadi pada perempuan yang memasuki usia 50 tahun. Rasa takut yang dialami oleh wanita antara lain, kecantikan memudar dan rasa khawatir akan kehilangan suami karena gairah seksual menurun. Setelah usia 45 tahun, seorang perempuan masih mengalami menstruasi tetapi tidak teratur lagi, sebagian perempuan telah mengalami gejala pre menopause. Penelitian ini dilakukan untuk mengetahui faktor-faktor yang memengaruhi kecemasan dalam menghadapi menopause di Desa Meunasah Dayah Kecamatan Peusangan Kabupaten Bireuen.Desain penelitian yang digunakan adalah penelitian analitik dengan pendekatan cross sectional. Penelitian ini telah dilakukan pada bulan Mei 2019. Populasi dalam penelitian ini adalah seluruh ibu premenopause yang berumur antara 40 sampai 50 tahun. Teknik pengambilan sampel yaitu dengan cara total sampling yang diperoleh dengan melakukan kunjungan rumah (door to door) sebanyak 163 orang.Dari hasil penelitian, menunjukkan menunjukkan nilai p (0,025) < p value (0,05) berarti ha diterima dan ho ditolak, artinya ada pengaruh antara pengetahuan dengan kecemasan dalam menghadapi menopause. Hasil perhitungan menunjukkan nilai p (0,182) > p value (0,05) berarti h0 diterima dan ha ditolak, artinya tidak ada pengaruh antara perubahan fisik dengan kecemasan dalam menghadapi menopause. Hasil perhitungan menunjukkan nilai p (0,009) < p value (0,05) berarti ha diterima dan ho ditolak, artinya ada pengaruh antara dukungan keluarga dengan kecemasan dalam menghadapi menopause. Diharapkan kepada responden agar meningkatkan lagi pengetahuan khususnya tentang tanda serta gejala yang terjadi menjelang menopause sehingga dapat mengurangi rasa cemas dan khawatir yang dirasakan.

Introduction: Body constitution (BC) is widely applied in daily clinical practice by Traditional Chinese Medicine (TCM) practitioners. The BC is innate depending on the intrinsic properties of the human body and is influenced by the environment. The most common diagnostic tool of physiological BC types is the Constitution in Chinese Medicine Questionnaire (CCMQ). This study was conducted to determine the proportion of nine TCM constitution types and comorbidities observed in the community of District 4, Ho Chi Minh City. Methods: A cross-sectional design was applied to collect data for this study. All the participants were classified as BC types by the CCMQ. The collected data were statistically analyzed with the SPSS 22.0 software. Results: There were 436 participants aged from 18 (163 males; 273 females) enrolled in this study from 05/2021 – 06/2021 in District 4. Five comorbidities were observed including hypertension (23.6%), cardiovascular diseases (13.1%), diabetes (11.5%), hyperlipidemia (8.3%) and obesity (4.1%). In participants, the prevalence of nine BC types were Neutral (62.4%), Qi-deficiency (17.2%), Qi-depression (15.6%), Inherited-special (8.9%), Yang-deficiency (8.3%), Blood-stasis (8.0%), Yin-deficiency (7.6%), Phlegm-dampness (6.4%), and Dampness-heat (5.7%). The Qi-deficiency type was significantly associated with ages, genders, hypertension and cardiovascular diseases while the Dampness-heat one was related to gender. Conclusions: Among the participants in District 4, Ho Chi Minh City, hypertension (23.6%) is the most common comorbidity. Neutral (62.4%) is the majority in BC types. The associations between BC types and ages, genders, jobs, five chronic diseases were different.

The ternary antimonides RE4T7Sb6 (RE=Gd-Lu; T =Ru, Rh) have been synthesized from the elements by arc-melting and subsequent annealing in an induction furnace. The samples have been characterized by powder X-ray diffraction. Four structures were refined on the basis of single-crystal X-ray diffractometer data: U4Re7Si6 type, space group Im3m with a=862.9(2) pm, wR2=0.0296, 163 F2 values for Er4Ru7Sb6; a=864.1(1) pm, wR2=0.1423, 153 F2 values for Yb4Ru7Sb6; a=872.0(2) pm, wR2=0.0427, 172 F2 values for Tb4Rh7Sb6; and a=868.0(2) pm, wR2=0.0529, 154 F2 values for Er4Rh7Sb6, with 10 variables per refinement. The structures have T1@Sb6 octahedra and slightly distorted RE@T26Sb6 cuboctahedra as building units. The distorted cuboctahedra are condensed via all trapezoidal faces, and this network leaves octahedral voids for the T1 atoms. The ruthenium-based series of compounds was studied by temperature-dependent magnetic susceptibility measurements. Lu4Ru7Sb6 is Pauli-paramagnetic. The antimonides RE4Ru7Sb6 with RE=Dy, Ho, Er, and Tm show Curie-Weiss paramagnetism. Antiferromagnetic ordering occurs at 10.0(5), 5.1(5) and 4.0(5) K for Dy4Ru7Sb6, Ho4Ru7Sb6 and Er4Ru7Sb6, respectively, while Tm4Ru7Sb6 remains paramagnetic. Yb4Ru7Sb6 is an intermediate-valent compound with a reduced magnetic moment of 3.71(1) μB per Yb as compared to 4.54 μB for a free Yb3+ ion

Abstrak Penelitian ini dilatarbelakangi rendahnya hasil belajar IPS. Hal tersebut disebabkan kurangnya pemahaman materi yang disampaikan guru, kurangnya variasi guru dalam proses belajar mengajar di dalam kelas, dan hasil belajar masih di bawah KKM. Tujuan yang hendak dicapai dalam penelitian ini adalah untuk mengetahui keefektifan model pembelajaran Jigsaw berbantuan LKS pada materi Menghargai Perjuangan Kemerdekaan Indonesia kelas V SDN Pleburan 03 Semarang dilihat pada ketuntasan belajar dan hasil belajar. Jenis penelitian ini adalah kuantitatif dalam bentuk True Eksperimental Design dengan desain desain Pre test – Post test Kontrol Design. Populasi penelitian adalah 40 siswa kelas VA dan VB siswa SDN Pleburan 03 Semarang. Hasil penelitian menunjukkan bahwa model pembelajaran Jigsaw berbantuan LKS efektif terhadap hasil belajar siswa. Hal ini terbukti dengan hasil analisis akhir dengan menggunakan Uji t-test didapatkan thitung= 3,218 ttabel= 2,021 dengan dk n_1+n_2 – 1 = 39 dan α = 5%. Sehingga diperoleh t hitung > t tabel yakni 3,218 > 2,021 maka Ho ditolak dan Ha diterima. Hal itu terbukti dengan nilai rata-rata dan ketuntasan belajar kelas eksperimen lebih baik daripada nilai rata-rata dan ketuntasan belajar kelas kontrol. Dimana nilai rata-rata kelas eksperimen sebesar 83,25, sedangkan nilai rata-rata kelas kontrol sebesar 75,75 dan ketuntasan belajar klasikal kelas eksperimen sebesar 95% sedangkan ketuntasan belajar kelas kontrol 90% Kata Kunci: Keefektifan, Jigsaw Abstract The background of this research is the low learning result of IPS lesson. It is caused by the lack of students’ understanding on the material delivered by the teacher, teacher variations on learning process in classroom, and the learning result still under Minimum Completeness Criteria (KKM). The aim to be achieved in this research is to find out the effectiveness of Jigsaw learning model assisted by LKS in material Respecting the Struggle of Indonesian Independence in SDN Pleburan 03 Semarang seen by the completeness of learning and learning result. Mega Wahyuningsih Keefektifan Model... 163 MAGISTRA - Volume 8 Nomor 2 Desember 2017 This research using quantitative in form True Experimental Design with Pre test - Post test Design Control. The population of the study was 40 students of VA and VB classes in SDN Pleburan 03 Semarang. The results showed that the Jigsaw learning model assisted by LKS is effective on student learning outcomes. This is prooved by the results of the final analysis using the t-test Test obtained t = 3.218 t table = 2.021 with dk n_1 + n_2 - 1 = 39 and α = 5%. So that t count> t table is 3,218> 2,021 then Ho is rejected and Ha is accepted. This is prooved by the average value and completeness of the experimental class learning better than the average value and completeness of learning the control class. Where the average value of the experimental class is 83.25, while the average value of the control class is 75.75 and the classical learning completeness of the experimental class is 95% while the completeness of the control class is 90%. Key Word: Efectivity, Jigsaw

Chinese hawthorn (Crataegus pinnatifida) is an important ornamental and economic horticultural plant. However, the lack of molecular markers has limited the development and utilization of hawthorn germplasm resources. Simple sequence repeats (SSRs) derived from expressed sequence tags (ESTs) allow precise and effective cultivar characterization and are routinely used for genetic diversity analysis. Thus, we first reported the development of polymorphic EST-SSR markers in C. pinnatifida with perfect repeats using Illumina RNA-Seq technique. In total, we investigated 14,364 unigenes, from which 5091 EST-SSR loci were mined. Di-nucleotides (2012, 39.52%) were the most abundant SSRs, followed by mono- (1989, 39.07%), and tri-nucleotides (1024, 20.11%). On the basis of these EST-SSRs, a total of 300 primer pairs were designed and used for polymorphism analysis in 70 accessions collected from different geographical regions of China. Of 239 (79.67%) pairs of primer-generated amplification products, 163 (54.33%) pairs of primers showed polymorphism. Finally, 33 primers with high polymorphism were selected for genetic diversity analysis and tested on 70 individuals with low-cost fluorescence-labeled M13 primers using capillary electrophoresis genotyping platform. A total of 108 alleles were amplified by 33 SSR markers, with the number of alleles (Na) ranging from 2 to 14 per locus (mean: 4.939), and the effective number of alleles (Ne) ranging from 1.258 to 3.214 (mean: 2.221). The mean values of gene diversity (He), observed heterozygosity (Ho), and polymorphism information content (PIC) were 0.524 (range 0.205–0.689), 0.709 (range 0.132–1.000), and 0.450 (range 0.184–0.642), respectively. Furthermore, the dendrogram constructed based on the EST-SSR separated the cultivars into two main clusters. In sum, our study was the first comprehensive study on the development and analysis of a large set of SSR markers in hawthorn. The results suggested that the use of NGS techniques for SSR development represented a powerful tool for genetic studies. Additionally, fluorescence-labeled M13 markers proved to be a valuable method for genotyping. All of these EST-SSR markers have agronomic potential and constitute a scientific basis for future studies on the identification, classification, and innovation of hawthorn germplasms.

Permasalahan lingkungan dapat menimbulkan dampak terhadap kondisi ekosistem dunia. Rumusan masalah kajian ini adalah bagaimanakah pengaturan perizinan di bidang lingkungan dan bagaimanakah penegakan hukum di bidang perizinan dapat mencegah dan menanggulangi pencemaran lingkungan hidup. Metode penelitian adalah penelitian hukum normatif. Hasil penelitian menunjukkan bahwa perizinan lingkungan di Indonesia yang berkaitan dengan permasalahan lingkungan telah diatur di berbagai macam perundang-undangan yang meliputi bidang pengairan, bidang pertambangan, bidang kehutanan, bidang perindustrian, bidang penataan ruang, bidang pertanahan, bidang pengolahan limbah B3, bidang pengendalian pencemaran dan atau kerusakan laut, bidang perikanan, bidang konservasi sumber daya alam hayati dan ekosistemnya serta izin ditingkat daerah yakni izin gangguan (HO). Dalam penegakannya dapat dilakukan melalui sarana hukum admintrasi dan hukum pidana.

Background: This article uses the term “way of living” in its connection with “place identity” to analyze the impact of new urban residents (migrant peasants) on the urban space transformation. In the thematic study of the spatial development of the Ho Chi Minh City center, the configuration of the influence of the key actors (state and community) is analyzed. The architectural environment of the Vietnamese Ho Chi Minh City (formerly known as Saigon) is considered in the context of the similarity of its development (consequences of development) to the transformation of the space of Ukrainian cities. Methods: Observations and theoretical discourse on the recent changes in the city’s spatial organization are used to create a detailed description of several quarters of the city center on which the study focuses. This description allows us to understand the nature of changes in the urban environment, which is expressed in the continuous (daily) deconstruction of the historical environment, and the main drivers of this process. Turning to the hypothesis of the influence of the new residents’ “way of life”, which is different from the one of the urban residents, the study was supplemented by the analysis of the spatial organization and neighborhood of the fishing village of Gành Dầu in the province of tỉnh Kiên Giang. Results: The study of the space-community interactions of this sustainable rural settlement determines the similarity of the “rural identity” of local residents with the “urban identity” (autochthonous urban population of Ho Chi Minh City) in terms of perception and use of the common space. Therefore, differences in lifestyle (urban/rural) are not the main source of influence on the gradual changes in urban morphology and the loss of authentic buildings. In the context of this study, the impact of “consumer identity” as a manifestation of a “fluid society” (characterized by instability and uncertainty) that is in the process of constant change is more noticeable. It is important to emphasize that the influence of the local community (with any type of identity) on the transformation of the urban space occurs only through the informal spatial practices, and is not the only or determining factor. Conclusions: Due to the similarity of the processes of the spatial development of the Vietnamese and Ukrainian cities, this study provides a significant comparative example for the analysis of the urban environment transformations. This study helps to introduce a new research program that addresses the gap between the architectural analysis of the interaction between the (substituted) community-space and research in other scientific fields.

Abstract Introduction MYC-rearrangement (MYC-R) occurs in approximately 10-15% of diffuse large B-cell lymphomas (DLBCL) and several studies suggest an inferior progression free (PFS) as well as overall survival (OS) compared to DLBCL without MYC-R. However, the prognostic significance of MYC single-hit (MYC-SH), MYC double/triple-hit (MYC and BCL2 and/or BCL6 translocation; MYC-DH/TH) in the context of the MYC translocation partner (MYC-IG versus MYC-non-IG) is less clear due to relatively small sample sizes in prior studies. The Lunenburg Lymphoma Biomarker Consortium (LLBC) set out to address these questions in a large number of DLBCL treated uniformly with rituximab (R)-CHOP- or R-CHOP-like chemotherapy. Methods Relevant clinical data (IPI factors, PFS, OS) from patients with aggressive B-cell lymphomas with confirmed DLBCL morphology derived from registry cohorts (Canada: British Columbia Cancer, UK: Leeds/HMRN, Barts, USA: Stanford) and prospective clinical trials (Germany: RICOVER, MegaCHOEP, France: LNH01-5B and LNH03-B, HOVON: HO 46 and 84) were pooled in the LLBC database (n=5118). Interphase FISH analysis (mostly on tissue microarrays) was used to determine the MYC-, BCL2- and BCL6-rearrangement status. All DLBCL with available tissue underwent break-apart testing for MYC (Vysis, LSI, Abbott). Identified MYC-R cases were subjected to FISH break-apart testing for the BCL2- and BCL6 loci as well as to MYC/IGH fusion testing and, if negative, to MYC/IGK and MYC/IGL testing to allow designation of the final MYC-R status (MYC-IG versus MYC-non-IG). Information on the cell of origin (COO) was generated using immunohistochemistry (Hans classifier) and/or gene expression based methods. Survival probabilities were estimated using the Kaplan Meier method and survival curves were compared with the log-rank test. The effects of variables of interest were estimated using univariate and multivariate Cox models stratified on the variable 'cohort' and 'trial'. Results 2380 DLBCL patients with full data on PFS, OS, IPI factors and MYC FISH results were available for analysis. 263 DLBCL cases (11%) had MYC-R which was associated with inferior PFS and OS compared to DLBCL patients without MYC-R (59% versus 72% OS at five years; log-rank <0.001; 56% versus 64% PFS at five years; log-rank <0.002). This effect was observed in both COO subgroups (GCB and non GCB). Out of 163 MYC-R patients with complete FISH data, 40 were MYC-SH with an IG partner (24.5%) and 17 (10.5%) with a non-IG partner. 53 patients had a MYC DH/TH constellation with an IG partner (32.5%) and 53 patients (32.5%) with a non-IG partner. The MYC-DH/TH group with an IG partner had the worst OS at 24 months: (50.9% compared to 76.4% for the remaining MYC-R DLBCL patients and to 82.4% for patients without MYC-R) (fig1). Similar results were obtained for PFS. In the MYC-DH group, there were no differences in OS and PFS between MYC/BCL2 and MYC/BCL6 'double hits'. Multivariate Cox models adjusting for the IPI and including a time-dependent effect showed, that the impact on outcomes was mainly seen in the first 24 months post therapy (hazard ratio (HR) of 2 [1.59-2.53] for MYC-R DLBCL patients compared to patients without MYC-R and a HR of 3.12 [2.09-4.64] for MYC-DH/TH tumors in which MYC is translocated to IG). In contrast, in MYC-R patients including MYC-SH and MYC-DH/TH without an IG partner, the HR was lower at 1.5 [1.01-2.24]. Conclusion This study by the LLBC in a very large cohort of DLBCL patients treated with R-CHOP or R-CHOP-like therapy confirms previous reports on the negative prognostic impact of an underlying MYC-translocation for both PFS and OS. This impact is predominantly observed in the first two years post therapy. Further, the large sample size extends previous observations that the partner gene of MYC (IG versus non-IG) also has prognostic impact. MYC-DH/TH DLBCL with an IG partner gene have the worst OS and PFS, while impact is moderate in other constellations (MYC-SH and MYC-DH/TH with a non-IG partner). Additionally, no differences between MYC/BCL2 and MYC/BCL6 'double hits' are seen in PFS and OS. Our results suggest that along with MYC testing in routine clinical practice, identification of the MYC partner gene (IG versus non-IG) is also warranted to identify further DLBCL subsets with poor outcomes which may have implications in the design and interpretation of future clinical trials. Figure 1. Figure 1. Disclosures Sehn: Merck: Consultancy, Honoraria; TG Therapeutics: Consultancy, Honoraria; Roche/Genentech: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria.

ABSTRAK Pengelolaan pembangunan desa islami adalah konsep pembangunan desa yang memiliki karakteristik tercapainya tujuan pembangunan sosial ekonomi yang berdimensi holistik, seimbang antara aspek material dan spiritual. Penelitian ini bertujuan untuk mengkaji pembahasan kajian-kajian terdahulu secara sistematis tentang konsep dan praktik pengelolaan pembangunan desa dalam perspektif islam. Dalam rangka melakukan review publikasi artikel secara sistematis, riset ini menggunakan standar protokol RAMESES. Hasil penelitian ini terbagi menjadi dua tema utama, yaitu peran dan fungsi lembaga keuangan mikro syariah dalam pembangunan desa dan Lembaga Swadaya Masyarakat dalam pengelolaan pembangunan desa. Tema pertama menghasilkan tiga subtema: praksis keuangan mikro syariah di Bangladesh, Malaysia, dan Indonesia. Tema kedua menghasilkan satu subtema yaitu peranan Pesantren dalam mendukung pengelolaan pembangunan desa. Hasilnya memberikan landasan untuk mengisi ruang-ruang yang belum dimasuki untuk membangun pengelolaan pembangunan desa yang komprehensif berdasarkan prinsip atau nilai Islam yang ideal. Kata kunci: Islami, Pengelolaan Pembangunan Desa, Systematic Literature Review. ABSTRACT Islamic village development management is a village development concept that has the characteristics of achieving socio-economic development goals with a holistic dimension, balanced between material and spiritual aspects. This study aims to systematically review the discussion of previous studies on the concepts and practices of village development management from an Islamic perspective. To conduct the article review systematically, this research was carried out using the RAMESES protocol standard. The results of this study are divided into two main themes, namely the role and function of Islamic microfinance institutions in village development and non-governmental organizations in managing village development. 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In this paper, seismic activity characteristics in the East Sea area was analyzed by authors on the base of the unified earthquake catalog (1900-2017), including 131505 events with magnitude 3 ≤ Mw ≤ 8.4. The seismic intensity in the East Sea during the period 1900-2017 is characterized by the earthquake representative level Mw = 4.7. The strong earthquake activity in the East Sea area clearly shows the regularity in each stage. In the period from 1900 to 2017, the East Sea area has four periods of strong earthquake activity, each stage is nearly 30 years with particular characteristics. The distribution of the maximum earthquake quantities by years has a cyclicity in all four periods. In each stage there are 1-2 strong earthquakes with Mmax ≥ 8.0. The strong earthquakes with Mmax ≥ 7.5 have occurred by a repeatable rule of 3-5 years in all four stages. This allows the prediction of the maximum earthquake repeat cycle of Mmax ≥ 7.5 in the study area is 3-5 years. In other hand, the maximum magnitude values for the East Sea region has assessed by GEV method with several different predict periods (20, 40, 60, 80, 100 years), with predicted probability 80%. We concluded that it is possible that earthquake have Mmax = 8.7 will occur in next 100 years.ReferencesBautista C.B., Bautista M.L.P., Oike K., Wu F.T., Punongbayan R.S., 2001. A new insight on the geometry of subducting slabs in northern Luzon, Philippines. Tectonophysics, 339, 279-310.Bui Cong Que, et al., 2010. Seismic and tsunamis hazard in coastal Viet Nam. Natural Science and Technology Publishing House, 311p.Bui Van Duan, Nguyen Cong Thang, Nguyen Van Vuong, Pham Dinh Nguyen, 2013. The magnitude of the largest possible earthquake in the Muong La-Bac Yen fault zone. J. Sci. of the Earth, 35, 53-59 (in Vietnamese).Cao Dinh Trieu, Pham Nam Hung, 2008. Deep-seated fault zone presents the risk of strong earthquakes in the East and South Vietnam Sea. 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This study aimed to examine the implementation pattern of the constructivist theory in limited face-to-face learning (PTMT). The method used was descriptive qualitative with the subject of teachers in the Malang City area. Data was collected by using a survey distributed online through Google Forms. The results showed that the implementation pattern ofconstructivist theory in limited face-to-face learning (PTMT) was carried out through 5 (five) base of learning implementation, namely the application of problem-based learning, the application of project-based learning, the use of digital-based teaching materials and media, the application of psychosocial learning and contextuallearning. Teachers carried out limited face-to-face learning by applying constructivist theory massively and gradually, starting from planning, the process of learning activities, and learning evaluation. In addition to the use of media and 5M learning models in this study, the application of constructivist theory in PTMT learning aimed to help students become more active and teachers as moderators be more innovative. Learning process carried out at the elementary school level was only 50 percent attendance at the maximum. The implementation of student-centered learning showed 45% was very good, 50% was good, 2.5% was good, 2.5% was not good. The results showed that the inhibiting factor for student-centered implementation was the limited duration of time in learning. On the other hand, there were also restrictions on interactions carried out in the classroom so that teachers experienced a decline in exploring the learning process. Keywords: constructivism theory. limited face-to-face learning, elementary school. References: Adiyono, A. 2021. Implementasi Pembelajaran: Peluang dan Tantangan Pembelajaran Tatap Muka Bagi Siswa Sekolah Dasar di Muara Komam. 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STEAM-based learning is a global issue in early-childhood education practice. STEAM content becomes an integrative thematic approach as the main pillar of learning in kindergarten. This study aims to develop a conceptual and practical approach in the implementation of children's education by applying a modification from STEAM Learning to R-SLAMET. The research used a qualitative case study method with data collection through focus group discussions (FGD), involving early-childhood educator's research participants (n = 35), interviews, observation, document analysis such as videos, photos and portfolios. The study found several ideal categories through the use of narrative data analysis techniques. The findings show that educators gain an understanding of the change in learning orientation from competency indicators to play-based learning. Developing thematic play activities into continuum playing scenarios. STEAM learning content modification (Science, Technology, Engineering, Art and Math) to R-SLAMETS content (Religion, Science, Literacy, Art, Math, Engineering, Technology and Social study) in daily class activity. Children activities with R-SLAMETS content can be developed based on an integrative learning flow that empowers loose part media with local materials learning resources. Keyword: STEAM to R-SLAMETS, Early Childhood Education, Integrative Thematic Learning References Ali, E., Kaitlyn M, C., Hussain, A., & Akhtar, Z. (2018). the Effects of Play-Based Learning on Early Childhood Education and Development. Journal of Evolution of Medical and Dental Sciences, 7(43), 4682–4685. https://doi.org/10.14260/jemds/2018/1044 Ata Aktürk, A., & Demircan, O. (2017). A Review of Studies on STEM and STEAM Education in Early Childhood. Journal of Kırşehir Education Faculty, 18(2), 757–776. Azizah, W. A., Sarwi, S., & Ellianawati, E. (2020). 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Embedding play-based learning into junior primary (Year 1 and 2) Curriculum in WA. Australian Journal of Teacher Education, 43(1), 112–126. https://doi.org/10.14221/ajte.2018v43n1.7 Kennedy, A., & Barblett, L. (2010). Supporting the Early Years Learning Framework. Research in Practise Series, 17(3), 1–12. Keung, C. P. C., & Cheung, A. C. K. (2019). Towards Holistic Supporting of Play-Based Learning Implementation in Kindergartens: A Mixed Method Study. Early Childhood Education Journal, 47(5), 627–640. https://doi.org/10.1007/s10643-019-00956-2 Keung, C. P. C., & Fung, C. K. H. (2020). Exploring kindergarten teachers’ pedagogical content knowledge in the development of play-based learning. Journal of Education for Teaching, 46(2), 244–247. https://doi.org/10.1080/02607476.2020.1724656 Krogh, S., & Morehouse, P. (2014). The Early Childhood Curriculum : Inquiry Learning Through Integration. Liao, C. (2016). From Interdisciplinary to Transdisciplinary: An Arts-Integrated Approach to STEAM Education. Art Education, 69(6), 44–49. https://doi.org/10.1080/00043125.2016.1224873 Lillard, A. S., Lerner, M. D., Hopkins, E. J., Dore, R. A., Smith, E. D., & Palmquist, C. M. (2013). The impact of pretend play on children’s development: A review of the evidence. Psychological Bulletin, 139(1), 1–34. https://doi.org/10.1037/a0029321 Maxwell, L. E., Mitchell, M. R., & Evans, G. W. (2008). Effects of Play Equipment and Loose Parts on Preschool Children’s Outdoor Play Behavior: An Observational Study and Design Intervention. Children, Youth and Environments, 18(2), 37–63. McLaughlin, T., & Cherrington, S. (2018). Creating a rich curriculum through intentional teaching. Early Childhood Folio, 22(1), 33. https://doi.org/10.18296/ecf.0050 Mengmeng, Z., Xiantong, Y., & Xinghua, W. (2019). Construction of STEAM Curriculum Model and Case Design in Kindergarten. 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Introducción: Los pacientes con cáncer de colon tienen un riesgo de obstrucción intestinal maligna (OIM). El objetivo del estudio fue determinar la prevalencia de la OIM en un grupo de pacientes con cáncer de colon en un centro de referencia regional público. Metodología: El presente estudio transversal se realizó en el Hospital General IESS Ceibos de Guayaquil -Ecuador de marzo 2017 a junio del 2020. Se incluyeron pacientes con cáncer de colon incidentes en el período de estudio. Las variables fueron edad, sexo, presencia de OIM. Se utiliza estadística descriptiva en frecuencias y porcentajes. Resultados: Se analizan 90 pacientes, 55 hombres (61.11%). La edad más prevalente fue el grupo de 61 a 70 años 27 casos (30%).La comorbilidad más prevalente fue la hipertensión arterial en el 36%. El tipo histológico predominante fue el adenocarcinoma de colon en el 94.44%. 61.11% tuvieron un tumor en el recto y 15.56% en la unión rectosigmoidea. La prevalencia de OIM fue de 55 casos 61.11% (IC95% 60.77-61.45%). En 15 casos (16.67%) fue obstrucción completa y 36 casos (40%) fue obstrucción parcial. La mortalidad fue de 52 casos (57.78%). La presencia del tumor en la unión rectosigmoidea OR=6.188 (IC95% 1.282-29.86) P=0.0232. Conclusión: La prevalencia de OIM es alta más del 61%. La presencia del tumor en la unión rectosigmoidea fue un factor de riesgo para el desarrollo de OIM. Recibido: Octubre 21, 2022 Aceptado: Noviembre 17, 2022 Publicado: Diciembre 3, 2022 Editor: Dra. Evelyn Valencia Espinoza. Introducción La obstrucción intestinal maligna (OIM) es común en pacientes con cánceres abdominales o pélvicos. Es más prevalente en el cáncer de ovario (5.5% a 42%), cáncer colorrectal (4.4% a 24%) y cáncer gástrico [1]. Con poca frecuencia, las metástasis de cánceres extraabdominales, incluidos el cáncer de mama, el cáncer de pulmón y el melanoma, pueden causar obstrucción intestinal maligna. La OIM se presenta con mayor frecuencia en pacientes con cáncer en etapa avanzada. Aunque la obstrucción del intestino delgado es más común, la obstrucción del intestino grueso ocurre en aproximadamente el 25% de todas las obstrucciones intestinales [2]. En un estudio de cohorte de 490 pacientes con cáncer, los sitios anatómicos de obstrucción se clasificaron como salida gástrica 16%, en el intestino delgado 64% y en el intestino grueso 20% [3]. La obstrucción puede ser funcional o debido a una obstrucción mecánica. Puede ser parcial o completa. En promedio, los pacientes con síntomas agudos se presentan después de unos cinco días de síntomas [4]. Este retraso puede estar relacionado con la naturaleza de los síntomas con distensión abdominal y malestar por distensión progresiva del colon, posiblemente mejor tolerado en comparación con el dolor abdominal y los vómitos que están asociados con la obstrucción del intestino delgado. Aproximadamente el 70 por ciento de las obstrucciones del intestino grueso ocurren en el colon transverso o distalmente al mismo [5]. El intestino se dilata proximal al sitio de la obstrucción y el líquido se secuestra debido a una reabsorción alterada. Pueden producirse cambios importantes de líquido, ya que se pueden secretar hasta 10 litros de líquido en el intestino por día. Esto se ve agravado por la reducción de la ingestión oral y los vómitos. Hay pérdida de volumen intravascular y depleción de electrolitos. Esto puede progresar a un shock hipovolémico. En la obstrucción mecánica, hay un aumento de la actividad peristáltica inicialmente en un intento de superar el bloqueo, lo que lleva a un dolor abdominal tipo cólico. Finalmente, el músculo liso intestinal se fatiga y la peristalsis se detiene. Distal a la obstrucción, el intestino se vacía, inicialmente a menudo da lugar a diarrea, antes de colapsar [6]. En la obstrucción adinámica o no mecánica en cambio, hay malestar abdominal debido a la distensión en lugar de dolor cólico y actividad peristáltica reducida o ausente [7]. Los cambios microvasculares pueden provocar la pérdida de la integridad de la mucosa y la translocación de bacterias al torrente sanguíneo, lo que lleva al desarrollo del síndrome de respuesta inflamatoria sistémica. Con la distensión progresiva de la pared intestinal, el retorno venoso puede impedirse y provocar una mayor congestión, pérdida de líquido en la luz del intestino y la fuga de líquido seroso hacia el abdomen, lo que provoca ascitis. La congestión venosa adicional compromete el flujo arterial hacia el lecho capilar, lo que produce isquemia intestinal. En última instancia, esto puede provocar necrosis y perforación de la pared intestinal. El objetivo del presente estudio transversal fue medir la prevalencia de la OIM en un grupo de pacientes con cáncer de colon referidos a un hospital público de influencia regional en Guayaquil-Ecuador. Materiales y métodos Diseño del estudio El presente estudio es transversal. La fuente es retrospectiva. Área de estudio El estudio se realizó en el servicio de estadística del Hospital General de los Ceibos del Instituto Ecuatoriano de Seguridad Social, en la ciudad de Guayaquil- Ecuador. El período de estudio fue del 1ro de Marzo del 2017 hasta el 30 de junio del 2020. Universo y muestra El universo fue conformado por todas las pacientes registrados en la institución. El cálculo del tamaño muestral fue no probabilístico, tipo censo, en donde se incluyeron todos los casos incidentes en el período de estudio. Participantes Se incluyeron casos de pacientes con diagnóstico de cáncer de colon. Se excluyeron casos metastásicos. Variables Las variables descriptivas fueron edad, sexo, año de atención, características histológicas, sitio del tumor, obstrucción intestinal, tipo de obstrucción, tabaquismo, alcoholismo, obesidad, historial de hemorroides, fallecimiento, tiempo de evolución. Procedimientos, técnicas e instrumentos. Los datos fueron tomados del expediente electrónico institucional (AS400) en un formulario diseñado exclusivamente para tal propósito. Se usaron los códigos de identificación de casos CIE-10: C18, C19 y C20. Evitación de sesgos Para garantizar la confiabilidad de la información los investigadores fueron entrenados sobre la recolección de los datos y uso del sistema AS400. Se usó una lista de doble chequeo para incluir los casos. Los datos fueron validados y curados por el investigador principal. Análisis estadístico Recopilada la información en una hoja electrónica Excel, se ingresó en una matriz de datos del software SPSS™ 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Se utilizó estadística descriptiva en base a frecuencias y porcentajes para las variables cualitativas y para las cuantitativas medidas de tendencia central. Resultados El análisis incluyó 90 pacientes. Caracterización clínica Fueron 55 hombres (61.11%) y 35 mujeres (38.89%). La edad más prevalente fue el grupo de 61 a 70 años (Tabla 1). El período de estudio se presenta en la segunda sección de la tabla 1, el año 2018 fue el de mayor incidencia. La mayoría de los casos fueron diagnosticados en hospitalización (Tabla 1). El 40% de los pacientes estudiados no presentó ningún tipo de comorbilidad. La enfermedad más prevalente fue la hipertensión arterial en el 36% de los casos (Sección 4, Tabla 1). Características del tumor El tipo histológico predominante fue el adenocarcinoma de colon en el 94.44% (Tabla 2). De los pacientes estudiados el 61.11% tuvieron un Tumor en el recto, seguido por el 15.56% que lo presentó en la unión rectosigmoidea y el 5.56% en el colon sigmoide. El 10% de los pacientes tenía un tumor en colon con ubicación no especificada en el expediente electrónico por lo que no pudo ser identificado el origen (Tabla 2). Prevalencia de obstrucción intestinal y mortalidad La prevalencia de la obstrucción intestinal en los pacientes estudiados fue de 55 casos 61.11% (IC95% 60.77-61.45%). En 15 casos (16.67%) fue obstrucción completa y 36 casos (40%) fue obstrucción parcial, en 4 casos no se pudo documentar el tipo de obstrucción específica. La mortalidad fue de 52 casos (57.78%). Análisis inferencial La prevalencia de la obstrucción intestinal en los pacientes estudiados fue de 55 casos 61.11% (IC95% 60.77-61.45%). En 15 casos (16.67%) fue obstrucción completa y 36 casos (40%) fue obstrucción parcial, en 4 casos no se pudo documentar el tipo de obstrucción específica. La mortalidad fue de 52 casos (57.78%) (Tabla 3). La presencia del tumor en la unión rectosigmoidea fue un factor de riesgo para el desarrollo de OIM (Tabla 3). Discusión La obstrucción intestinal ocurre cuando el intestino delgado o el colon están parcial o completamente bloqueados. El bloqueo evita que los alimentos, los líquidos y los gases pasen normalmente por los intestinos y es una complicación que comúnmente afecta a pacientes con cáncer colorrectal. El presente estudio reveló una prevalencia de obstrucción intestinal en los pacientes con cáncer de colon del Hospital General IESS Ceibos de la ciudad de Guayaquil de marzo 2017 a junio 2020 del 61.11%. Los pacientes de sexo masculino fueron los más frecuentes con 61.11% del total. La comorbilidad más frecuente fue la hipertensión arterial con el 36%, seguido por el alcoholismo y la diabetes, ambas con el 8%. El 94.44% presentó un adenocarcinoma, el 61.11% tuvo un tumor en el recto, seguido por el 15.56% que lo presentó en la unión rectosigmoidea y el 5.56% en el colon sigmoide. Además el 65% de los pacientes presentó una obstrucción intestinal parcial y la tasa de mortalidad de los pacientes de nuestro estudio fue del 57.78%. En una cohorte que incluyó todos los pacientes con cáncer de EE. UU. hospitalizados con obstrucción intestinal maligna en 2006 y 2010 con datos obtenidos de la muestra de pacientes hospitalizados a nivel nacional proporcionados por la Agencia para la investigación y la calidad de la atención médica se determinó que la prevalencia de la obstrucción intestinal fue de entre el 25 - 40% de los pacientes [8]. La edad media de los pacientes en el momento del ingreso hospitalario fue de 66 años, se observó una diferencia significativa en función del sexo, con un mayor número de pacientes mujeres (52% vs 48%; P<0.001). En comparación con el presente estudio tuvo una prevalencia de obstrucción intestinal mayor (61.11%) a la informada por la cohorte y además el género predominante fue el masculino. La edad promedio en ambos estudios fue parecida ya que en nuestro estudio la edad promedio de los pacientes fue de 62 ± 11 años en comparación a los 66 años informado por este estudio de Estados Unidos. En otro estudio poblacional de incidencia y factores de riesgo asociados de pacientes con cáncer de colon en estado IV con el uso de la base de datos de Vigilancia, Epidemiología y Resultados Finales (SEER) –Medicare [9], se concluyó que de los 12.553 pacientes con cáncer de colon, 1004 (8.0%) fueron hospitalizados con obstrucción intestinal después del diagnóstico de cáncer. En esta gran población de pacientes con cáncer de colon en estadio IV, la Obstrucción intestinal después del diagnóstico fue menos común (8.0%) de lo que se informó anteriormente incluyendo los resultados del presente estudio que están muy por encima de este porcentaje. Finalmente, la obstrucción intestinal fue más común entre los que tenían tumores adenocarcinomas mucinosos en comparación con los no mucinosos (el 10.4 frente al 7.6%; P<0.001). La tasa de mortalidad fue del 94% en el último seguimiento, superior a la tasa de mortalidad del 57.78% reportada en este estudio. Otro estudio realizado en Perú [10] que analizó a 114 pacientes con neoplasia maligna de colon, 14 de los 42 pacientes con cáncer de colon presentaron un tipo de obstrucción intestinal, representando un 33% de los pacientes estudiados. La media de edad fue de 60.5 años, y predominó el género femenino con 66.7%. El 100% de los tipos histológicos fue adenocarcinoma. Se halló 33.3% en colon ascendente y 21.4% en colon sigmoides. En concordancia, con este estudio el 94.44% presentó un adenocarcinoma, sin embargo hubo una diferencia en el sitio predominante del tumor, mientras en este estudio de Perú fue en el colon ascendente y colon sigmoides, en nuestro estudio el 61,11% tuvo un tumor en el recto, seguido por el 15.6% que lo presentó en la unión rectosigmoidea. Además, tal como pasó con el estudio realizado en Estados Unidos, [8] el presente estudio tuvo discrepancia con el predominio del género masculino y una mayor prevalencia de la obstrucción intestinal. En conclusión, aunque nuestro estudio difiere en algunos resultados respecto a otros estudios de mayor tamaño, debido a que hubo algunas limitaciones en este estudio por el número de pacientes relativamente pequeño en comparación a un estudio multicéntrico, establece una base sólida para la realización de futuras investigaciones en el Ecuador sobre factores de riesgo y prevalencia de las obstrucciones intestinales en los pacientes con cáncer de Colon. Este estudio estuvo sujeto a ciertas limitaciones potenciales. El uso de datos secundarios confiere una falta de comprensión sobre cómo se recopilaron los datos originales. Por ejemplo, es posible que se haya perdido parte de la información del paciente o se haya registrado incorrectamente. Esto, a su vez, puede dar lugar a estimaciones inferiores o superiores al hallazgo. En la medida de lo posible, se intentó gestionar y minimizar estas limitaciones mediante una cuidadosa selección de los registros de los pacientes. Conclusiones La prevalencia de obstrucción intestinal en los pacientes con cáncer de colon en el presente reporte fue del 61.1%. El 65% de los pacientes presentó una obstrucción intestinal parcial. Los pacientes de sexo masculino fueron los más frecuentes con 61.1% del total y que la edad promedio de los pacientes fue de 62 ± 11 años. El 94.4% presentó un adenocarcinoma. El 61.1% tuvo un tumor ubicado en el recto. La mortalidad de los pacientes fue del 57.8%. %. La presencia del tumor en la unión rectosigmoidea fue un factor de riesgo para el desarrollo de OIM. Agradecimientos Los autores agradecen a los funcionarios y pacientes del Hospital General de los Ceibos del Instituto Ecuatoriano de Seguridad Social, que colaboraron en el desarrollo de esta investigación. Información administrativa Abreviaturas OIM: Obstrucción intestinal maligna. IC: Íntervalo de confianza. Archivos Adicionales Ninguno declarado por los autores. Fondos Los autores no recibieron ningún tipo de reconocimiento económico por este trabajo de investigación. Disponibilidad de datos y materiales Existe la disponibilidad de datos bajo solicitud al autor de correspondencia. No se reportan otros materiales. Contribuciones de los autores Jorge Luis Márquez Coronel: conceptualización, validación, visualización, metodología, administración de proyecto, escritura: revisión y edición. John Enmil Saltos Carvajal: conceptualización, curación de datos, análisis formal, adquisición de fondos, investigación, recursos, software, redacción - borrador original. Tania Triana: conceptualización, validación, visualización, metodología, administración de proyecto, escritura: revisión y edición. Todos los autores leyeron y aprobaron la versión final del manuscrito. Aprobación del comité de ética No aplica a estudios observacionales. Consentimiento para publicación No aplica cuando no se publican imágenes, radiografía o tomografías de los pacientes. Referencias Chen JH, Huang TC, Chang PY, Dai MS, Ho CL, Chen YC, Et al. Malignant bowel obstruction: A retrospective clinical analysis. Mol Clin Oncol. 2014 Jan;2(1):13-18. DOI: 10.3892/mco.2013.216. Epub 2013 Nov 19. PMID: 24649301; PMCID: PMC3915666. Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007 Jan 21;13(3):432-7. DOI: 10.3748/wjg.v13.i3.432. PMID: 17230614; PMCID: PMC4065900. Pujara D, Chiang YJ, Cormier JN, Bruera E, Badgwell B. Selective Approach for Patients with Advanced Malignancy and Gastrointestinal Obstruction. J Am Coll Surg. 2017 Jul;225(1):53-59. DOI: 10.1016/j.jamcollsurg.2017.04.033. Epub 2017 May 5. PMID: 28483604. Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned. J Gastrointest Surg. 2011 Jan;15(1):110-9. DOI: 10.1007/s11605-010-1360-2. Epub 2010 Oct 26. PMID: 20976568. Buechter KJ, Boustany C, Caillouette R, Cohn I Jr. Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg. 1988 Sep;156(3 Pt 1):163-8. DOI: 10.1016/s0002-9610(88)80056-4. PMID: 3048132. Domínguez EJ. Factores predictivos de mortalidad vinculados con alteraciones del medio interno en la oclusión intestinal mecánica. Panorama Cuba y Salud 2015;10(1):10-17. Redalyc: 77347 Mercadante S, Kargar J, Nicolosi G. Octreotide may prevent definitive intestinal obstruction. J Pain Symptom Manage. 1997 Jun;13(6):352-5. DOI: 10.1016/s0885-3924(97)00084-5. PMID: 9204656. Alese OB, Kim S, Chen Z, Owonikoko TK, El-Rayes BF. Management patterns and predictors of mortality among US patients with cancer hospitalized for malignant bowel obstruction. 2015 Jun 1;121(11):1772-8. DOI: 10.1002/cncr.29297. Epub 2015 Mar 4. PMID: 25739854. Winner M, Mooney SJ, Hershman DL, Feingold DL, Allendorf JD, Wright JD, Neugut AI. Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. JAMA Surg. 2013 Aug;148(8):715-22. DOI: 10.1001/jamasurg.2013.1. PMID: 23740130; PMCID: PMC4507521. Machicado E, Giraldo R, Fernández K. Localización y clínica asociada al cáncer de colon. Hospital Nacional Arzobispo Loayza: 2009 – 2013. Horiz Med 2015; 15 (2):49-55. Scielo: 15n2 Nota del Editor Revista Oncología Ecu permanece neutral con respecto a los reclamos jurisdiccionales en mapas publicados y afiliaciones institucionales.

Introducción: La Enfermedad Renal Crónica (ERC) tiene una evolución natural hacia la pérdida de la función renal progresiva, sin embargo existe controversia si la progresión tiene un ritmo constante y predecible. El objetivo del presente estudio fue identificar los factores de riesgo asociados a la progresión en un grupo de niños con ERC. Métodos: El presente estudio longitudinal, fue realizado en un seguimiento de menores de 16 años con diagnóstico de ERC en estadios 3 y 4 en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, de octubre 2014 a octubre 2015. Se midió somatometría, tensión arterial, creatinina, hemoglobina, colesterol, triglicéridos, fósforo, bicarbonato, proteinuria y progresión de ERC. Se compara la muestra entre los que presentaron progresión (P-ERC) y los que no (SP-ERC). Se presentan valores con medianas. Resultados: Participaron 35 pacientes, de 10 años de edad, 18 mujeres (54.4%), 57% con malformaciones de las vías urinarias. Seguimiento por 2.95 años, la tasa de filtrado glomerular (TFG) fue 31.7ml/min/1.73m2. En estadio 3, 20 pacientes, de 8.7 años, 60% mujeres. En estadio 4, 15 pacientes, de 11.4 años, 66.7% hombres. La disminución de TFG fue de 6.7 ml/min/1.73m2/año, siendo de 6.6 para el estadio 3 y de 2.8 para el estadio 4. El nivel de colesterol se asoció a la progresión del daño renal (P=0.03). Otros factores no fueron significativos. En ambos grupos incrementó el número de pacientes con obesidad. (P>0.05). Conclusión: En el primer año el 50% de los pacientes tuvo P-ERC. Los pacientes en estadio 3 tienen una velocidad mayor P-ERC. La hipercolesterolemia es un factor de progresión de ERC en niños. Recibido: Julio 25, 2022 Aceptado: Septiembre 30, 2022 Publicado: Septiembre 30, 2022 Editor: Dr. Franklin Mora Bravo. Introducción La progresión de la enfermedad renal crónica (ERC) en niños es influenciada por una variedad de factores, algunos de los cuales pueden ser modificables como la hipertensión arterial, poteinuria, control glucémico, obesidad, dislipidemia, anemia y factores metabólicos [1]. Los niños con ERC no tienen el mismo perfil epidemiológico que los adultos y probablemente los factores modificables tengan un patrón distinto al de los adultos [2]. En lo que respecta a proteinuria en la edad pediátrica, en el proyecto Italkid evaluó pacientes con riñones hipoplásicos , dividiéndolos en 3 grupos: un grupo sin proteinuria, otro con proteinuria leve (índice proteínas/creatinina 0.2– 0.9) y el tercero con proteinuria moderada (índice proteínas/creatinina > 0.9). Se definió progresión de la ERC al deterioro de la función renal > 3 ml/min/1.73m2 por año. Los pacientes se siguieron en un promedio 3 años y medio; se observó mayor deterioro de la función renal en pacientes del grupo con proteinuria moderada con disminución de la tasa de filtrado glomerular (TFG) de 3.61 ± 5.4 ml/min/1.73 por año, en comparación a los grupos sin proteinuria o proteinuria leve (0.16 ± 3.64 y 0.54 ± 3.67 ml/min/1.73m2 por año, respectivamente), (P < 0.0001) [3]. Sobre el control de la hipertensión en niños, en el corte realizado en el 2003 del estudio NAPRTCS, Mitsnefes et. al [4] analizaron 3,834 pacientes con edad entre 2 y 17 años con una TFG < 75 ml/min/1.73m2. El punto final del estudio se definió como el inicio de la terapia de sustitución o un deterioro de la TFG de 10 ml/min/1.73 m2 con respecto a la inicial. En los resultados se describe que los niños que presentaban hipertensión en el momento del inicio del seguimiento, tuvieron mayor proporción de deterioro que quienes tenían presión arterial normal (58% vs. 49%); mientras que al realizar el análisis multivariado, la hipertensión arterial sistólica se determinó como un factor independiente (P = 0.003) de deterioro de la función renal. Existen pocos estudios que documenten la prevalencia de dislipidemia en niños y adolescentes con ERC. Un meta-análisis de Fried et al. de un total de 362 pacientes con ERC en ensayos clínicos con número pequeño de participantes, sugiere que el tratamiento de la dislipidemia se asoció con mejoría de 1.9 ml/min de TFG, al compararse con controles sin este tratamiento [5], mientras que en un estudio realizado en el 2011 por Holl R y cols en pacientes adolescentes alemanes, suizos y austriacos se demostró que por cada 10 ml/min/1.73 m2 de disminución de la TFG, existe una correlación positiva con el incremento en colesterol, triglicéridos y colesterol no HDL, así como una correlación negativa con el colesterol HDL. En particular en los niños con TFG < 30 ml/min/1.73m2, tuvieron mayor riesgo de presentar dislipidemia [6]. Sobre la anemia como factor de progresión, un estudio multicéntrico y prospectivo de 23 adolescentes con ERC de entre los 11 y 18 años observados cada 6 meses por un período de 3 años reportó una disminución de la TFG de 5.6 ml/min/1.73m2 por año, y fue mayor la disminución en pacientes con anemia (hematocrito < 36%): 7.8 ml/min/1.73m2 (IC95%: 3.3 – 12ml/min/1.73m2) [7]. Actualmente existe evidencia que la acidosis metabólica contribuye a la progresión de la enfermedad renal en adultos y en niños [8]. Los niños con enfermedad renal crónica tienen una alta prevalencia de síndrome metabólico y obesidad, estos niños, experimentan una disminución más rápida de la función renal [9], comparada con los niños con IMC normal. Con estos antecedentes se estableció como objetivo del presente estudio el identificar los factores asociados con el deterioro de la función renal, en pacientes pediátricos con enfermedad renal crónica en estadios 3 y 4 en un centro nacional de referencia pediátrica en México con un seguimiento mínimo de 6 meses. Materiales y métodos Diseño del estudio El presente estudio es observacional, descriptivo, de tipo longitudinal. Escenario El estudio se realizó en el departamento de nefrología en la Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, de México DF, México, durante el periodo de 1ro de octubre del 2014 al 1ro de octubre del 2015. Participantes Se incluyeron pacientes pediátricos con el diagnóstico de enfermedad renal crónica estadios 3 y 4 que fueron valorados en la consulta externa de la institución. Se excluyeron pacientes con trasplante renal. Se excluyeron pacientes que cumplieron la mayoría de edad, que perdieron la continuidad del control en la consulta externa. Se eliminaron casos con datos incompletos para el análisis, con historias clínicas incompletas o sin seguimiento posterior al ingreso. Variables Las variables fueron: -anemia, proteinuria en rango nefrótico, hipercolesterolemia, hipertrigliceridemia, hiperfosfatemia, hipertensión arterial sistólica, hipertensión arterial diastólica, etiología de la enfermedad renal crónica, obesidad, edad, sexo. Se consideró como variables de Confusión al tratamiento recibido, al tiempo de evolución de la ERC y el estadio de la ERC. La variable dependiente fue la progresión de la enfermedad renal crónica. Fuentes de datos/mediciones La fuente fue indirecta, se revisó el expediente electrónico institucional, el registro de los servicios de estadística, nefrología y consulta externa. La tasa de filtrado glomerular (TFG) en este estudio se estimó calculando la Depuración de Creatinina con la fórmula de Schwartz update, Sesgos Con el fin de evitar posibles sesgos de entrevistador, de información y de memoria, los datos fueron custodiados durante todo el tiempo por el investigador principal con una guía y registros aprobados en el protocolo de investigación. El sesgo de observación y selección fueron evitados con la aplicación de los criterios de selección de los participantes. Se consignaron todas las variables clínicas y paraclínicas del periodo ya comentado. Dos investigadores de manera independiente analizaron cada uno de los registros por duplicado y se consignaron las variables en la base de datos una vez verificada su concordancia. Tamaño del estudio La muestra fue no probabilística, tipo censo, en donde se incluyeron todos los casos posibles del período en estudio, ya que existe una baja prevalencia de ERC en la población pediátrica que acude a la institución. Variables cuantitativas Se utilizó estadística descriptiva e inferencial. Se expresaron los resultados en escala en medias y desviación estándar. Los datos categóricos como el sexo se presentan en proporciones. Análisis estadístico Se utiliza estadística no inferencial e inferencial. Análisis descriptivo: Se calcularon de acuerdo con la escala de medición de cada una de las variables, medidas de tendencia central y dispersión. Para las variables cualitativas se presentarán con números absolutos y porcentajes; para las variables cuantitativas, con mediana como medida de tendencia central y como medidas de dispersión los valores mínimo y máximo. Análisis inferencial: La comparación entre dos grupos para las variables cuantitativas se realizará con la prueba de U de Mann - Whitney, y la comparación de proporciones con la prueba Chi-cuadrada. No se realizó el cálculo de razón de momios (OR) para la identificación de factores relacionados con la progresión. El nivel de significancia estadística fue de P < 0.05. El paquete estadístico utilizado fue SPSS 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Resultados Participantes Se estudiaron 35 pacientes, de un total de 79 pacientes (Figura 1). Características basales de la población de estudio La mediana de edad al momento de la primera consulta fue 10 años, fueron 18 mujeres (54.4%), la mediana de seguimiento global fue de 2.95 años, se calculó una mediana de tasa de filtrado glomerular (TFG) estimada por talla de 31.7ml/min/1.73m2. Las malformaciones de las vías urinarias fue la etiología más común (57%): reflujo vesicoureteral, vejiga neurogénica, valvas de uretra posterior. Se clasificó a la población de estudio por la tasa de filtrado glomerular, situándose en estadio 3 o 4 de Enfermedad Renal Crónica (ERC). El grupo de pacientes en estadio 3 lo conformaron 20 pacientes, la mediana para la edad fue de 8.7 años, siendo un 60% del sexo femenino, la mediana de seguimiento fue de 2.8 años. El grupo de pacientes en estadio 4 estaba conformado por 15 pacientes, cuya mediana de edad fue de 11.4 años, el 66.7% fueron de sexo masculino, con una mediana de seguimiento de 3.1 años (véase tabla 1). Para ambos estadios, las malformaciones de vías urinarias fueron la etiología más frecuente. Evaluación de la función renal y velocidad de progresión La tasa de filtrado glomerular (TFG) tuvo una mediana global al inicio del estudio de 31.7ml/min/1.73m2, para el estadio 3 fue de 42.5ml/min/1.73m2 y del estadio 4 fue de 18 ml/min/1.73m2.En 18 pacientes (54.42%) se observó una disminución de la tasa de filtrado glomerular de más de 3 ml/min/1.73m2 por año, 11 (31.4%) pacientes no tuvieron disminución de la Depuración de Creatinina de más de 3ml/min/1.73m2 por año y en 6 pacientes (17.5%) se observó mejoría de la Depuración de Creatinina. La mediana de velocidad de progresión global de 6.7ml/min/1.73m2 por año, siendo de 6.6ml/min/1.73m2 por año para los pacientes en estadio 3 y de 2.8ml/min/1.73 por año para los que se situaban en estadio 4. Factores asociados a la progresión de la enfermedad renal Al inicio del estudio las variables no fueron diferentes entre ambos grupos (Tabla 2). Al clasificar cada factor de acuerdo al punto de corte de anormalidad, observamos que en el grupo de pacientes situados en estadio 3, el porcentaje de pacientes con hipertensión arterial tanto sistólica como diastólica era más alto con respecto al grupo que corresponde al estadio 4; por otra parte, el porcentaje que corresponde a la proteinuria nefrótica, la hipercolesterolemia y la hipertrigliceridemia era mayor en este último grupo. El porcentaje que corresponde a la anemia, la acidosis metabólica y la hiperfosfatemia eran similares para ambos grupos (véase tabla 3). Análisis por progresión de la ERC En el grupo que presentó progresión de la enfermedad renal, incrementaron la mediana de la proteinuria y los triglicéridos con respecto al inicio. Disminuyeron las medianas de las percentiles de tensión arterial sistólica y colesterol (ver tabla 4).El grupo sin progresión de la enfermedad renal crónica, presentó disminución en la mediana para los triglicéridos, para el resto de las variables identificadas no hubo una diferencia estadística (ver tabla 4). Sólo los niveles de colesterol elevados al inicio de seguimiento se asocian a la progresión del daño renal (P=0.03). Comparando los grupos que progresaron o no, de acuerdo al comportamiento de los factores con punto de corte de anormalidad, para el grupo de pacientes con progresión se observó que más pacientes tenían hipertrigliceridemia, hipercolesterolemia, acidosis metabólica e hiperfosfatemia al final de seguimiento a pesar del tratamiento instaurado. Además menos pacientes presentaron proteinuria nefrótica. Para el grupo sin progresión, disminuyó el número de pacientes con hipertensión arterial, hipertrigliceridemia, acidosis metabólica e hiperfosfatemia e incremento el número de pacientes con proteinuria nefrótica. En ambos grupos incrementó el número de pacientes con obesidad (véase tabla 5). Ninguno de los factores estudiados al inicio del estudio se asoció a progresión de ERC. Debido al tamaño de muestra no se pudo calcular el riesgo de progresión de la función renal por factor asociado al mismo. Discusión Una de las etiologías más frecuentes de la ERC en niños son las malformaciones de las vías urinarias, en este estudio fue la causa más frecuente. En las niñas la malformación más frecuente fue el reflujo vesicoureteral y en niños las valvas uretrales posteriores. Este comportamiento se podría explicar por el mecanismo de daño menos agresivo en el reflujo vesicoureteral a diferencia de las valvas uretrales posteriores, en el que gran parte del daño es en etapa intrauterina. Por lo tanto si bien hay más niñas con malformación en etapa 3, en la etapa 4 predominan los hombres. Tanto en el proyecto ItalKid [3] como en el proyecto REPIR II [1], estudiaron pacientes pediátricos desde el estadio 2 al 5, reportaron como etiología más común las malformaciones de las vías urinarias en el 53.6 y 59% respectivamente. En el North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) [4], que reúne información de la población pediátrica de Estados Unidos, México y Canadá, con ERC en estadio 3 al 5 también reportó a las uropatías como principal causa de enfermedad renal crónica (48%), también esta prevalencia ha sido reportada en Latinoamérica [10]. La mediana de la Tasa de filtrado glomerular (TFG) encontrada al inicio de este estudio fue de 31.7ml/min/1.73m2, siendo menor con respecto al proyecto ItalKid (41.7ml/min/1.73 m2) y proyecto REPIR II (39.5ml/min/1.73 m2), estos estudios incluyen pacientes desde el estadio 2 al 5 sin terapia de sustitución renal. En este estudio se calculó una mediana de pérdida de TFG de 6.6ml/min/1.73 m2 por año en el estadio 3. Si consideramos que estos pacientes iniciaron con una mediana de TFG de 42.ml/min/1.73, entonces podrían requerir terapia de sustitución renal en aproximadamente 3 años. En los pacientes en estadio 4 que tuvieron una mediana de TFG inicial de 18ml/min/1.73m2, se calculó una velocidad de progresión de daño renal de 2.8ml/min/1.73m2 por año y considerando que la mayor parte de los pacientes ingresan a diálisis con una TFG menor a 10ml/min/1.73, se espera que este grupo se encuentre en terapia de sustitución renal en 3 años. La proteinuria es uno de los principales factores asociados a la progresión del daño renal, condicionando inflamación intersticial y fibrosis. Ardissino y cols, [3] en el 2004 demostraron una asociación entre la progresión de la ERC y proteinuria, donde se correlacionó la proteinuria inicial, como un factor predictivo de daño renal. En este estudio, no se demostró estadísticamente ser un factor de progresión, probablemente por el bajo número de casos incluidos. La hipertensión arterial es un factor asociado a la progresión del daño renal, ya que condiciona un aumento en la presión intraglomerular que conduce hipertrofia glomerular y glomérulo esclerosis. En el presente estudio, no se logró demostrar diferencia estadística de hipertensión como factor de riesgo de progresión; este resultado es diferente a lo encontrado en el NAPRTCS23, donde participaron 3834 pacientes, de 2 a 17 años de edad, con una TFG menor a 75ml/min/1.73m2. Se identificó que el 48% de los pacientes eran hipertensos al inicio del estudio. Además de diferencias estadísticamente significativas entre los pacientes hipertensos y normo tensos (58% vs 49%, respectivamente P<0.0001) con una TFG entre 50-75ml/min/1.73m2, (P<0.0001). La dislipidemia condiciona daño endotelial capilar en células mesangiales y podocitos. En pacientes con enfermedad renal crónica, el patrón lipídico típico consiste en elevación de triglicéridos (TG) y descenso de la HDL-colesterol, sobre todo a partir del estadio 3. Estudios experimentales han demostrado que la dislipidemia condiciona el desarrollo de proteinuria y daño glomerular progresivo, sin la presencia de cambios hemodinámicos. En este estudio hubo mayor frecuencia de hipertrigliceridemia en los pacientes en estadio 4 en comparación del estadio 3 (40% vs 30%), lo que es consistente con la hipótesis de que a mayor daño renal hay más hiperlipidemia, aunque en el seguimiento la proporción en ambos grupos diferenciados según la progresión no hubo diferencia. Saland y cols [11] en el 2009, en el estudio CKiD, estudiaron la dislipidemia en niños con enfermedad renal crónica, incluyeron 391 menores de 16 años. Mostró alta prevalencia de hipertrigliceridemia en 126 pacientes, con una mediana 106mg/dl, aumento de colesterol no HDL en 62 y reducción de HDL en 83. La disminución de la tasa de filtrado glomerular se relacionó con el aumento de los niveles de triglicéridos en un 8% en promedio (95%IC: 5%, 11%) por cada 10 ml/min/1.73m2 por disminución de la tasa de filtración glomerular. Corroboraron que la hipertrigliceridemia se asocia a la disminución del filtrado glomerular. Para este estudio no fue posible demostrarlo, debido al tamaño de muestra. Sin embargo, la mediana de triglicéridos en el grupo que presentó progresión fue mayor a lo reportado. Con respecto al colesterol en este estudio se observó que existió asociación de la progresión con cifras altas de colesterol al inicio del estudio (P=0.03), además de incremento en la frecuencia tanto en el grupo que progresó como el que no, sin embargo la proporción fue mayor la hipercolesterolemia en el grupo que progreso al inicio. Al respecto Holl R y cols [12], en el 2011, realizaron un estudio en pacientes adolescentes alemanes, suizos y austriacos se demostró que por cada 10 ml/min/1.73 m2 de disminución de la TFG, existe una correlación positiva con el incremento en colesterol, triglicéridos y colesterol no HDL, así como una correlación negativa con el colesterol HDL. En particular en los niños con TFG < 30 ml/min/1.73, tuvieron mayor riesgo de presentar dislipidemia. La hipercolesterolemia aislada inducida por dieta se asocia en diferentes modelos experimentales a daño glomerular del tipo de la glomeruloesclerosis focal y segmentaria e insuficiencia renal progresiva. La anemia se ha relacionado con hipoxia celular, incrementa el estrés oxidativo, influyendo en el deterioro de la función renal; además de la sintomatología propia de cualquier anemia crónica, repercute en las funciones cognitivas y especialmente en el sistema cardiovascular, sobre todo contribuye al desarrollo de hipertrofia ventricular izquierda. En este estudio el 25% de los pacientes cursaron con anemia al inicio, teniendo una proporción similar en ambos grupos. Esto difiere con lo reportado en estudio NAPRTCS23, donde la prevalencia de anemia en niños fue de 73% en estadio 3, 87% en la etapa 4 y más del 93% en la etapa 5. En REPIR II [1], se reportó un 30% de pacientes con anemia, así a medida que progresaba la enfermedad aumentaba el porcentaje de anémicos siendo del 14, del 33, del 58 y del 54%, en los estadios 2, 3, 4 y 5, respectivamente. Esto es esperado ya que a medida que avanza la enfermedad renal, disminuye la masa renal y con ello la producción de eritropoyetina. La obesidad está relacionada con la aparición temprana de glomerulomegalia, alteraciones hemodinámicas del riñón hiperfiltrante y aumento de la albuminuria, manifestaciones relacionadas con el tiempo de evolución y grado de severidad, pero reversibles con una pérdida de peso. La tasa más elevada de niños con enfermedades crónicas del riñón responde a un índice más alto de obesidad infantil, además la asociación entre obesidad y proteinuria, por glomeruloesclerosis focal segmentaria en adolescentes, que podría dar lugar a importantes secuelas renales [13]. Cao y cols [14] en el 2015, estudiaron a 6852 pacientes de 20 a 79 años, para identificar si la coexistencia de síndrome metabólico es una condición necesaria para desarrollar ERC en pacientes con sobrepeso y obesidad. En el seguimiento de 5 años, 776 pacientes desarrollaron ERC (TFG menor a 60ml/min/1.73). El riesgo de ERC, ajustado a proporciones de riesgo multivariable para peso normal en personas sin síndrome metabólico vs en sobrepeso fue de 1.31 (95% CI, 0.89 a 1.92) y para obesos fue de 2.39 (IC del 95%, 1.27- 4.52), siendo más alto en los pacientes con síndrome metabólico con peso normal de 1.54 (IC 95%, 1.18-3.95), 2.06 (95% CI, 1.27 a 3.36) en sobrepeso, y CI 2.77 (95%,1.42 a 4.31) en los individuos obesos con síndrome metabólico. Lo que sugiere que el sobrepeso y la obesidad, por si solos son factores de riesgo para enfermedad renal crónica, independiente de la presencia o no de síndrome metabólico. En este estudio, 10% de los pacientes eran obesos al inicio, al comparar las proporciones al inicio del estudio, se identificó mayor proporción en el grupo que progresó. Conclusiones Durante el primer año de seguimiento se observó que aproximadamente el 50% de los pacientes tuvo progresión de la enfermedad renal. Los pacientes en estadio 3 tienen una velocidad mayor de deterioro de progresión de la enfermedad renal en comparación con los que se encuentran en el estadio 4 (6.6ml/min/1.73m2 vs 2.8ml/min/1.73m2).Entre los factores de progresión renal que se estudiaron el único factor que se relacionó con la progresión fue la hipercolesterolemia al inicio del seguimiento. Es posible que el tratamiento dirigido a los diferentes factores relacionados con la progresión esté relacionado con la falta de asociación de otros factores. Abreviarturas ERC: Enfermedad renal crónica. HTA: hipertensión arterial. TFG: Tasa de filtrado glomerular. Información suplementaria Materiales suplementarios no han sido declarados. Agradecimientos No aplica. Contribuciones de los autores Alma Rebeca Mota Nova: Conceptualización, Curación de datos, Análisis formal, Adquisición de fondos, Investigación, Metodología, Administración de proyecto, Recursos, Software, Escritura – borrador original. María Alejandra Aguilar Kitsu: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Miguel Angel Villasis Keever: Metodología, validación, supervisión, redacción: Revisión y edición. Todos los autores leyeron y aprobaron la versión final del manuscrito. Financiamiento Los autores proveyeron los gastos de la investigación. Disponibilidad de datos o materiales Los conjuntos de datos generados y analizados durante el estudio actual no están disponibles públicamente debido a la confidencialidad de los participantes, pero están disponibles a través del autor correspondiente a pedido académico razonable. Declaraciones Aprobación del comité de ética y consentimiento para participar Este estudio fue aprobado por el comité de ética en investigación de la Unidad Médica de Alta Especialidad Hospital de Pediatría CMNO, aprobación número R-2021-1302-077. Consentimiento para publicación No aplica cuando no se publican imágenes o fotografías del examen físico o radiografías/tomografías/resonancias de pacientes. Conflictos de interés Los autores reportan no tener conflictos de interés. Referencias Areses R, Sanahuja M, Navarro M. Epidemiología de la enfermedad renal crónica no terminal en la población pediátrica española. Proyecto REPIR II. Nefrología 2010; 30:508-17. SCIELO:S0211 García de Vinuesa S. Factores de progresión de la enfermedad renal crónica. Prevención secundaria. Nefrología 2008; 3: 17-21.SCIELO: 32352 Ardissino G, Daccò V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, Marra G, Edefonti A, Sereni F; ItalKid Project. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003 Apr;111(4 Pt 1):e382-7. DOI: 10.1542/peds.111.4.e382. PMID: 12671156. Mitsnefes M, Ho PL, McEnery PT. Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol. 2003 Oct;14(10):2618-22. DOI: 10.1097/01.asn.0000089565.04535.4b. PMID: 14514740. Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol. 2006 Jul;17(7):2006-16. DOI: 10.1681/ASN.2006010012. Epub 2006 Jun 8. PMID: 16762986. Holl RW, Hoffmeister U, Thamm M, Stachow R, Keller KM, L'Allemand D, Widhalm K, Flechtner-Mors M, Wiegand S. Does obesity lead to a specific lipid disorder? Analysis from the German/Austrian/Swiss APV registry. Int J Pediatr Obes. 2011 Sep;6 Suppl 1:53-8. DOI: 10.3109/17477166.2011.604325. PMID: 21905817. Furth SL, Cole SR, Fadrowski JJ, Gerson A, Pierce CB, Chandra M, Weiss R, Kaskel F; Council of Pediatric Nephrology and Urology, New York/New Jersey; Kidney and Urology Foundation of America. The association of anemia and hypoalbuminemia with accelerated decline in GFR among adolescents with chronic kidney disease. Pediatr Nephrol. 2007 Feb;22(2):265-71. DOI: 10.1007/s00467-006-0313-1. Epub 2006 Nov 21. PMID: 17120062 Brown DD, Roem J, Ng DK, Reidy KJ, Kumar J, Abramowitz MK, Mak RH, Furth SL, Schwartz GJ, Warady BA, Kaskel FJ, Melamed ML. Low Serum Bicarbonate and CKD Progression in Children. Clin J Am Soc Nephrol. 2020 Jun 8;15(6):755-765. DOI: 10.2215/CJN.07060619. Epub 2020 May 28. PMID: 32467307; PMCID: PMC7274283. Lalan S, Jiang S, Ng DK, Kupferman F, Warady BA, Furth S, Mitsnefes MM. Cardiometabolic Risk Factors, Metabolic Syndrome, and Chronic Kidney Disease Progression in Children. J Pediatr. 2018 Nov;202:163-170. DOI: 10.1016/j.jpeds.2018.06.007. Epub 2018 Jul 2. PMID: 30041938; PMCID: PMC6203642. Piedrahita V, Flórez J, Martínez J, Prada M, Vanegas J, Vélez C, Serna L, Serrano A, Cornejo J. Causas de enfermedad renal crónica en niños atendidos en el Servicio de Nefrología Pediátrica del Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, entre 1960 y 2010Iatreia [en linea] 2011, 24 (Octubre- Diciembre). REDALYC:180522525001 Saland JM, Pierce CB, Mitsnefes MM, Flynn JT, Goebel J, Kupferman JC, Warady BA, Furth SL; CKiD Investigators. Dyslipidemia in children with chronic kidney disease. Kidney Int. 2010 Dec;78(11):1154-63. DOI: 10.1038/ki.2010.311. Epub 2010 Aug 25. PMID: 20736985; PMCID: PMC3222564. Holl RW, Hoffmeister U, Thamm M, Stachow R, Keller KM, L'Allemand D, Widhalm K, Flechtner-Mors M, Wiegand S. Does obesity lead to a specific lipid disorder? Analysis from the German/Austrian/Swiss APV registry. Int J Pediatr Obes. 2011 Sep;6 Suppl 1:53-8. DOI: 10.3109/17477166.2011.604325. PMID: 21905817. Gunta SS, Mak RH. Is obesity a risk factor for chronic kidney disease in children? Pediatr Nephrol. 2013 Oct;28(10):1949-56. DOI: 10.1007/s00467-012-2353-z. Epub 2012 Nov 14. PMID: 23150030. Cao X, Zhou J, Yuan H, Wu L, Chen Z. Chronic kidney disease among overweight and obesity with and without metabolic syndrome in an urban Chinese cohort. BMC Nephrol. 2015 Jun 18;16:85. DOI: 10.1186/s12882-015-0083-8. PMID: 26084279; PMCID: PMC4471928. Nota del Editor La REV SEN se mantiene neutral con respecto a los reclamos jurisdiccionales sobre mapas publicados y afiliaciones institucionales.

AbstractThe electron capture in $$^{163}\mathrm {Ho}$$ 163 Ho experiment (ECHo) is designed to directly measure the effective electron neutrino mass by analysing the endpoint region of the $$^{163}\mathrm {Ho}$$ 163 Ho electron capture spectrum. We present a data reduction scheme for the analysis of high statistics data acquired with the first phase of the ECHo experiment, ECHo-1k, to reliably infer the energy of $$^{163}\mathrm {Ho}$$ 163 Ho events and discard triggered noise or pile-up events. On a first level, the raw data is filtered purely based on the trigger time information of the acquired signals. On a second level, the time profile of each triggered event is analysed to identify the signals corresponding to a single energy deposition in the detector. We demonstrate that events not belonging to this category are discarded with an efficiency above 99.8%, with a minimal loss of $$^{163}\mathrm {Ho}$$ 163 Ho events of about 0.7%. While the filter using the trigger time information is completely energy independent, a slight energy dependence of the filter based on the time profile is precisely characterised. This data reduction protocol will be important to minimise systematic errors in the analysis of the $$^{163}\mathrm {Ho}$$ 163 Ho spectrum for the determination of the effective electron neutrino mass.

AbstractThe determination of the effective electron neutrino mass by analyzing the end point region of the $$^{163}$$ 163 Ho electron capture (EC) spectrum relies on the precise description of the expected $$^{163}$$ 163 Ho events and background events. In the ECHo experiment, arrays of metallic magnetic calorimeters, implanted with $$^{163}$$ 163 Ho, are operated to measure the $$^{163}$$ 163 Ho EC spectrum. In an energy range of 10 eV below $$Q_{\mathrm {EC}}$$ Q EC , the maximum available energy for the EC decay of about 2.8 keV, a $$^{163}$$ 163 Ho event rate of the order of $$10^{-4}$$ 10 - 4 day$$^{-1}$$ - 1 pixel$$^{-1}$$ - 1 is expected for an activity of 1 Bq of $$^{163}$$ 163 Ho per pixel. This means, a control of the background level in the order of $$10^{-5}$$ 10 - 5 day$$^{-1}$$ - 1 pixel$$^{-1}$$ - 1 is extremely important. We discuss the results of a Monte Carlo study based on simulations, which use the GEANT4 framework to understand the impact of natural radioactive isotopes close to the active detector volume in the case of the ECHo-1k set-up, which is used for the first phase of the ECHo experiment. For this, the ECHo-1k set-up was modeled in GEANT4 using the proper geometry and materials, including the information of screening measurements of some materials used in the ECHo-1k set-up and reasonable assumptions. Based on the simulation and on assumptions, we derive the expected background around $$Q_{\mathrm {EC}}$$ Q EC and give upper limits of tolerable concentrations of natural radionuclides in the set-up materials. In addition, we compare our results to background spectra acquired in detector pixels with and without implanted $$^{163}$$ 163 Ho. We conclude that typical concentration of radioactive nuclides found in the used materials should not endanger the analysis of the endpoint region of the $$^{163}$$ 163 Ho EC spectrum for an exposure time of half a year.

AbstractThe determination of the absolute mass scale of neutrinos is one of the most important challenges in Particle Physics. The shape of the endpoint region of $$\beta ^-$$ β - -decay and electron capture (EC) spectra depends on the phase space factor, which, in turn, is function of the masses of the neutrino mass eigenstates. High energy resolution and high statistics measurements of $$\beta ^-$$ β - and EC spectra are therefore considered a model-independent way for the determination of the neutrino mass scale. Since almost four decades, low temperature microcalorimeters are used for the measurement of low energy $$\beta ^-$$ β - and EC spectra. The first efforts were focused on the development of large arrays for the measurement of the $$^{187}$$ 187 Re $$\beta ^-$$ β - -spectrum. In the last ten years, the attention moved to EC of $$^{163}$$ 163 Ho. This choice was mainly motivated by the very good performance which could be achieved with low temperature microcalorimeters enclosing $$^{163}$$ 163 Ho with respect to microcalorimeters with absorber containing $$^{187}$$ 187 Re. The development of low temperature microcalorimeters for the measurement of the finite neutrino mass is discussed and, in particular, the reasons for moving from $$^{187}$$ 187 Re to $$^{163}$$ 163 Ho. The possibility to reach sub-eV sensitivity on the effective electron neutrino mass with $$^{163}$$ 163 Ho, thanks to the multiplexing of large microcalorimeter arrays is demonstrated. In conclusion, an overview on other nuclides which have been proposed as good candidates, motivated by the excellent performance of low temperature microcalorimeters is presented.

AbstractFor above ground particle physics experiments, cosmic muons are common source of background, not only for direct detector hits, but also for secondary radiation created in neighboring materials. The ECHo experiment has been designed for the determination of the effective electron neutrino mass by the analysis of the endpoint region of the $$^{163}\text {Ho}$$ 163 Ho electron capture spectrum. The fraction of events occurring in the region of interest of 10 eV below the $$Q_{\mathrm {EC}}$$ Q EC value of about 2.8 keV is only of the order of $$10^{-9}$$ 10 - 9 . This means that the background in that region need to be studied, characterized and methods to suppress it need to be developed. We expect a major background contribution to be due to cosmic muons and radiation produced by muons traveling through material around the detectors. To determine the muon-related background in metallic magnetic calorimeters (MMCs) used in the ECHo experiment, we have performed an experiment in which a muon veto was installed around the cryostat used for the operation of the detectors. We analysed the acquired events to investigate the pulse shape of MMC events in coincidence with the muon veto and the rate of multiple coincidences among detector array pixels. With different methods used for identification of muon related events, we studied events generated by muons and secondary radiation depositing energy in the substrate close to the ECHo pixels. In addition, energy depositions of muons and secondary radiation in the detectors was studied via Monte Carlo simulation. At the present status of investigation, we conclude that muon related events will be a negligible background in the region of interest of the $$^{163}\text {Ho}$$ 163 Ho spectrum.

Abstract The specific heat of dilute alloys of holmium in gold and in silver plays a major role in the optimization of low temperature microcalorimeters with enclosed $$^{163}{{\text {Ho}}}$$ 163 Ho , such as the ones developed for the neutrino mass experiment ECHo. We investigate alloys with atomic concentrations of $$x_{{{\text {Ho}}}}=0.01{-}4\%$$ x Ho = 0.01 - 4 % at temperatures between 10 and $$800\,{{{\hbox {mK}}}}$$ 800 mK . Due to the large total angular momentum $$J=8$$ J = 8 and nuclear spin $$I=7/2$$ I = 7 / 2 of $${{\text {Ho}}}^{3+}$$ Ho 3 + ions, the specific heat of Au:Ho and Ag:Ho depends on the detailed interplay of various interactions, including contributions from the localized 4f electrons and nuclear contributions via hyperfine splitting. This makes it difficult to accurately determine the specific heat of these materials numerically. Instead, we measure their specific heat by using three experimental setups optimized for different concentration and temperature ranges. The results from measurements on six holmium alloys demonstrate that the specific heat of these materials is dominated by a large Schottky anomaly with its maximum at $$T\approx 250\,{{{\hbox {mK}}}}$$ T ≈ 250 mK , which we attribute to hyperfine splitting and crystal field interactions. RKKY and dipole–dipole interactions between the holmium atoms cause additional, concentration-dependent effects. With regard to ECHo, we conclude that for typical operating temperatures of $$T\le 20\,{{{\hbox {mK}}}}$$ T ≤ 20 mK , silver holmium alloys with $$x_{{{\text {Ho}}}}\gtrsim 1\%$$ x Ho ≳ 1 % are suited best.

AbstractThe determination of the effective electron neutrino mass via kinematic analysis of beta and electron capture spectra is considered to be model-independent since it relies on energy and momentum conservation. At the same time the precise description of the expected spectrum goes beyond the simple phase space term. In particular for electron capture processes, many-body electron-electron interactions lead to additional structures besides the main resonances in calorimetrically measured spectra. A precise description of the $$^{163}$$163Ho spectrum is fundamental for understanding the impact of low intensity structures at the endpoint region where a finite neutrino mass affects the shape most strongly. We present a low-background and high-energy resolution measurement of the $$^{163}$$163Ho spectrum obtained in the framework of the ECHo experiment. We study the line shape of the main resonances and multiplets with intensities spanning three orders of magnitude. We discuss the need to introduce an asymmetric line shape contribution due to Auger–Meitner decay of states above the auto-ionisation threshold. With this we determine an enhancement of count rate at the endpoint region of about a factor of 2, which in turn leads to an equal reduction in the required exposure of the experiment to achieve a given sensitivity on the effective electron neutrino mass.

AbstractThe electron capture in $$^{163}$$ 163 Holmium (ECHo) experiment seeks to achieve sub-eV sensitivity of the electron neutrino mass through calorimetric decay spectroscopy of $$^{163}$$ 163 Ho in large arrays of cryogenic magnetic microcalorimeters (MMCs). Microwave SQUID multiplexing serves to efficiently increase the number of readout channels, thus calorimeters per array and ultimately per cryostat. A corresponding frequency multiplexing room temperature software-defined radio (SDR) system is in development to enable the readout of this increased number of MMCs per cable. The SDR consists of a custom FPGA platform that provides signal generation and analysis capabilities, as well as tailored signal conversion and analog conditioning front end electronics that enable the room-temperature-to-cryogenic interface. Ultimately, the system will read out 400 multiplexer channels with double pixel detectors through a bandwidth of 4 GHz (IEEE C band). As high-resolution data converters are limited in sample rate, the C-band is split into five sub-bands using a two-stage mixing method. In this contribution, a prototype of the heterodyne RF design is presented. It comprises one of the five 800 MHz sub-bands for a target frequency range between 4 and 8 GHz. Furthermore, the second version of the A/D converter stage is presented, capable of generating and digitizing up to five complex basebands using 1 GSs$$^{-1}$$ - 1 converters, the reference clocks and a flux-ramp signal. We will show first results of their single and combined characterization in the lab. The current state of the prototype hardware enables preliminary measurements, only limited in bandwidth and with slightly higher noise. Potential improvements could be derived and will be implemented in the full bandwidth, 5-sub-band RF PCB design.

Penelitian ini bertujuan untuk mengetahui korelasi antara tingkat pengetahuan lingkungan dengan sikap masyarakat dalam menjaga kebersihan lingkungan di Gampong Cot Siren Samalanga Kabupaten Bireuen. Populasi dalam penelitian ini adalah seluruh masyarakat yang berdomisili di Gampong Cot Siren Samalanga Kabupaten Bireuen yang berjumlah 317 jiwa terdiri dari 154 orang laki-laki dan 163 orang perempuan yang terbagi dalam 92 kepala keluarga (KK). Sampel penelitian ditetapkan 25% dari total kepala keluarga (KK), sehingga jumlah sampel 23 kepala keluarga yang berada di Gampong Cot Siren Samalanga Kabupaten Bireuen. Instrumen penelitian berupa soal tes dan angket. Teknik pengolahan data dilakukan dengan cara uji korelasi dan uji t. hasil peneltiian menunjukkan bahwa hasil analisis data diperoleh nilai rata-rata pengetahuan masyarakat adalah 69.35 (Cukup Baik) dan nilai rata-rata sikap masyarakat dalam menjaga kebersihan lingkungan adalah 67,04 (kategori Cukup Baik). Hasil uji korelasi di peroleh nilai r sebesar 0,490 yang berada pada interval koefisien 0.40 – 0.599 maka terdapat hubungan yang “Sedang” antara pengetahuan lingkungan dengan sikap masyarakat dalam menjaga kebersihan lingkungan di Gampong Cot Siren Samalanga Kabupaten Bireuen. Berdasarkan hasil uji t menunjukkan bahwa thitung > ttebel (2,5725 > 2,074). maka Ho ditolak dan Ha diterima, artinya ada korelasi antara tingkat pengetahuan lingkungan dengan sikap masyarakat dalam menjaga kebersihan lingkungan di Gampong Cot Siren Samalanga Kabupaten Bireuen

Abstract Following the reviews of atomic-weight determinations and other cognate data in 2015, 2017, 2019 and 2021, the IUPAC (International Union of Pure and Applied Chemistry) Commission on Isotopic Abundances and Atomic Weights (CIAAW) reports changes of standard atomic weights. The symbol A r°(E) was selected for standard atomic weight of an element to distinguish it from the atomic weight of an element E in a specific substance P, designated A r(E, P). The CIAAW has changed the values of the standard atomic weights of five elements based on recent determinations of terrestrial isotopic abundances: Ar (argon): from 39.948 ± 0.001 to [39.792, 39.963] Hf (hafnium): from 178.49 ± 0.02 to 178.486 ± 0.006 Ir (iridium): from 192.217 ± 0.003 to 192.217 ± 0.002 Pb (lead): from 207.2 ± 0.1 to [206.14, 207.94] Yb (ytterbium): from 173.054 ± 0.005 to 173.045 ± 0.010 The standard atomic weight of argon and lead have changed to an interval to reflect that the natural variation in isotopic composition exceeds the measurement uncertainty of A r(Ar) and A r(Pb) in a specific substance. The standard atomic weights and/or the uncertainties of fourteen elements have been changed based on the Atomic Mass Evaluations 2016 and 2020 accomplished under the auspices of the International Union of Pure and Applied Physics (IUPAP). A r° of Ho, Tb, Tm and Y were changed in 2017 and again updated in 2021: Al (aluminium), 2017: from 26.981 5385 ± 0.000 0007 to 26.981 5384 ± 0.000 0003 Au (gold), 2017: from 196.966 569 ± 0.000 005 to 196.966 570 ± 0.000 004 Co (cobalt), 2017: from 58.933 194 ± 0.000 004 to 58.933 194 ± 0.000 003 F (fluorine), 2021: from 18.998 403 163 ± 0.000 000 006 to 18.998 403 162 ± 0.000 000 005 (Ho (holmium), 2017: from 164.930 33 ± 0.000 02 to 164.930 328 ± 0.000 007) Ho (holmium), 2021: from 164.930 328 ± 0.000 007 to 164.930 329 ± 0.000 005 Mn (manganese), 2017: from 54.938 044 ± 0.000 003 to 54.938 043 ± 0.000 002 Nb (niobium), 2017: from 92.906 37 ± 0.000 02 to 92.906 37 ± 0.000 01 Pa (protactinium), 2017: from 231.035 88 ± 0.000 02 to 231.035 88 ± 0.000 01 Pr (praseodymium), 2017: from 140.907 66 ± 0.000 02 to 140.907 66 ± 0.000 01 Rh (rhodium), 2017: from 102.905 50 ± 0.000 02 to 102.905 49 ± 0.000 02 Sc (scandium), 2021: from 44.955 908 ± 0.000 005 to 44.955 907 ± 0.000 004 (Tb (terbium), 2017: from 158.925 35 ± 0.000 02 to 158.925 354 ± 0.000 008) Tb (terbium), 2021: from 158.925 354 ± 0.000 008 to 158.925 354 ± 0.000 007 (Tm (thulium), 2017: from 168.934 22 ± 0.000 02 to 168.934 218 ± 0.000 006) Tm (thulium), 2021: from 168.934 218 ± 0.000 006 to 168.934 219 ± 0.000 005 (Y (yttrium), 2017: from 88.905 84 ± 0.000 02 to 88.905 84 ± 0.000 01) Y (yttrium), 2021: from 88.905 84 ± 0.000 01 to 88.905 838 ± 0.000 002

Objectives: To investigate the correlation between the concentration in blood of bone minerals: Phosphorus, calcium, PTH, vitamin D, β2 microglobulin, aluminium with some clinical and subclinical factors in patients with dialysis chronic kidney patients. Materials and Methods: Descriptive cross-sectional study, include 163 patients with dialysis chronic kidney disease, from January 2017 to December 2018 at the Department of Haemodyalysis, District 2 Hospital, Ho Chi Minh City. Results: Serum phosphorus is negatively correlated with age r = - 0.342; positively correlated with albumin: r = 0.156, urea: r = 0.328, creatinine: r = 0.175, calcium x phosphorus index: r = 0.809,PTH: 0.273. Corrected serum calcium is negatively correlated with albumin: r = - 0.917, Hb: r = - 0.369, urea: r = - 0.178, creatinine: r = - 0.188, calcium x phosphorus index: r = 0.492. Plasma PTH positively correlated with dialysis time: r = 0.336, β2 microglobulin: r = 0.247; negatively correlated with Aluminum: r = - 0.161. Serum vitamin D negatively correlated with age: r = - 0.166, β2microglobulin: r = - 0.231. Serum aluminium positively correlated with diastolic blood pressure: r = 0.207 and systolic: r = 0.209. Serum β2 microglobulin positively correlated with dialysis time: r = 0.233, urea: r = 0.168; negatively correlated with Aluminum: r = - 0.224. Conclusion: Some bone mineral in dialysis patients are correlated with age, dialysis time, blood pressure, albumin, urea, creatinine. There is also a intercorrelation between bone minerals. Therefore, it is necessary to screen for bone mineral disorders and correlations as recommended by KDOQI, KDIGO. Key words: End-stage chronic kidney disease, dialysis, correlation, bone mineral disorders

Abstract Quaternary climate oscillations and complex topography have tremendous effects on current distribution and genetic structure of species, and hence the Qinghai–Tibet Plateau (QTP), the largest plateau in the world, has become a hotspot for many phylogeographic studies. However, little is known about the phylogeographic pattern of herbaceous plants in QTP. Here, we investigate the genetic diversity, population structure and historical dynamics of Iris loczyi, using five chloroplast DNA (cpDNA) fragments and seven microsatellite markers. A total of 15 populations, and 149 individuals were sampled throughout the QTP. High genetic diversity was detected both in cpDNA (Hd = 0.820) and SSR (Ho = 0.689, He = 0.699). Ten cpDNA haplotypes and 163 alleles were identified. AMOVA and clustering analyses revealed obvious differentiation between regions. The Nst, Gst and Mantel test showed significant phylogeographic structure of I. loczyi. The neutrality test and mismatch distribution analyses indicated that I. loczyi could not have undergone a historical population expansion, but population XS from the Qilian Mountain area could have experienced a local expansion. Bottleneck analyses indicated that I. loczyi had not experienced bottleneck recently. Based on cpDNA and SSR results, the Qilian Mountain area was inferred as a potential glacial refuge, and the southern Tibet valley was considered as a ‘microrefugia’ for I. loczyi. These findings provided new insights into the location of glacial refuges for the species distributed in QTP, and supplemented more plant species data for the response of QTP species to the Quaternary climate.

Objectives: To investigate the correlation between bone density and osteoporosis with some clinical and subclinical factors in patients with dialysis chronic kidney patients. Materials and Methods: Descriptive cross-sectional study, include 163 patients with dialysis chronic kidney disease, from January 2017 to December 2018 at the Department of Haemodyalysis, District 2 Hospital, Ho Chi Minh City. Results: Bone density was negatively correlated with age at the lumbar spine (LS) (r = - 0.225), total hip (total H) (r = - 0.288), femoral neck (FN) (r = - 0.352); with urea at the total H (r = - 0.206), FN (r = - 0.194); with PTH at LS (r = - 0.266), total H (r = - 0.219), FN (r = - 0.168); with β2 Microglobulin at the LS (r = - 0.269). Bone density was positively correlated with glomerular filtration rate at the LS (r = 0.200), FN (r = 0.179); with vitamin D at the LS (r = 0.218) and total H (r = 0.179). Multivariate regression analysis of the risk of decreased bone density at the FN has 2 factors: age (OR = 1.117), PTH (OR = 1.001); at the LS, there are 3 factors: gender (OR = 4.572), PTH (OR=4.078), age (OR = 1.045); at the total H, there are 2 factors: PTH (OR = 3.683), age (OR = 1.117). Osteoporosis in all 3 positions was related to sex (p < 0.05) and age group (p < 0.01). Osteoporosis was associated with PTH, Phosphorus, Aluminum disorders at the FN (p < 0.05), with PTH at the LS (p < 0.05), with PTH, calcium at the total H (p < 0.05). Multivariate regression analysis of the risk of osteoporosis has 3 factors: age (OR = 4.058), PTH (OR = 2.967), female (OR = 2.841). Conclusion: Bone density, osteoporosis is correlated, associated with common factors and factors associated with bone mineral disorders in patients with dialysis chronic kidney disease (CKD - MBD). Key words: End-stage chronic kidney disease, dialysis, bone density

BackgroundThe incidence of hematogenous osteomyelitis is on the rise, and the prognosis is poor. There has been no large-scale epidemiological analysis of hematogenous osteomyelitis in the world, and the treatment method is still controversial.MethodsA retrospective case study method was used to collect and analyze clinical data obtained from patients with hematogenous osteomyelitis in a tertiary hospital in Northwest China from January 1, 2011, to December 31, 2020. The aim of this study was to investigate the epidemiological status, microbiological characteristics, treatment and financial burden of hematogenous osteomyelitis in Northwest China to explore the therapeutic effects of different treatment methods, elucidate the epidemiological characteristics of hematogenous osteomyelitis and to provide a basis for the choice of treatment.ResultsWe included 259 patients with hematogenous osteomyelitis, including 96 patients with acute hematogenous osteomyelitis and 163 patients with chronic hematogenous osteomyelitis. The cause of the disease was not obvious in most patients, the sex ratio of males to females was 1.98, and the three most common infected sites were the tibia, femur and phalanx. Regarding preoperative serum inflammatory markers, the rate of positivity for ESR was the highest at 67.58%. Among pathogenic microorganisms, Staphylococcus aureus was the most common. Regarding the financial burden, the median total cost per patient was 25,754 RMB, and medications accounted for the largest proportion of the main costs.ConclusionsThe most common pathogen associated with HO infection was MSSA. Oxacillin has good PK and PD and is recommended as the first-line drug. Some blood-borne bone infections may lead to complications, such as pulmonary infection through bacteremia, which requires early detection to avoid a missed diagnosis. Regarding surgical intervention, debridement plus absorbable calcium sulfate bone cement and calcium sulfate calcium phosphate bone cement exclusion have achieved good therapeutic effects, but they are worthy of further in-depth research. Regarding the financial burden, the median total cost per patient was 25,754 RMB. The financial burden of blood-borne osteomyelitis was lower than that of traumatic osteomyelitis. Among the main costs, drugs accounted for the largest proportion.

The aims of study was formulation and evaluation of berberin (BBR) loaded proliposomes by spray-drying method. BBR proliposomes were evaluated for appearance, spray-drying efficiency, morphology and differential scanning calorimetry (DSC). Liposomes, obtained after hydration, were evaluated for particle size, size distribution, morphology and entrapment efficiency. The results showed that BBR proliposomes were prepared by spray-drying method with molar ratio of Hydrogenated soy phosphatidyl choline (HSPC): Sodium deoxycholat (NaDC): vitamin E (vtE): BBR = 7: 1: 6: 6. Mixture of manitol and Aerosil at weight ratio of 97:3 was used as carrier. Results of DSC showed that berberin was dispersed molecularly into proliposomes powder. BBR liposomes, obtained after hydration, had average particle diameter of about 29 μm and entrapment efficiency was 22.23%. Keywords Proliposomes, liposomes, berberin, sodium deoxycholate, spray-dried. References [1] W. Kong, J. Wei, A. Parrveen et al., Berberine is A Novel Cholesterol-Lowering Drug Working Through A Unique Mechanism Distinct From Statins, Nature Medicine, Vol. 10, No. 12, 2004, pp. 1344-1351, https://doi.org/10.1038/nm1135.[2] S. K. Kulkarni, A. Dhir, on The Mechanism of Antidepressant-Like Action of Berberine Chloride, European Journal of Pharmacology, Vol. 589, No. 1-3, 2008, pp. 163-172, https://doi.org/ 10.1016/j.ejphar.2008.05.043.[3] Y. T. Ho, J. S. Yang, T. C. Li et al., Berberine Suppresses in Vitro Migration and Invasion of Human SCC-4 Tongue Squamous Cancer Cells Through the Inhibitions of FAK, IKK, NF-Κb, U-PA and MMP-2 and-9, Cancer Letters, Vol. 279, No. 2, 2009, pp. 155-162, https://doi.org/10.1016/j.canlet.2009.01.033.[4] S. Muneer, Z. Masood, S. Butt et al., Proliposomes as Pharmaceutical Drug Delivery System: A Brief Review, Journal of Nanomedicine and Nanotechnology, Vol. 8, No. 3, 2017, pp. 448-450, https://doi.org/10.4172/2157-7439.1000448.[5] H. K. Omer, N. R. Hussein, A. Ferraz et al., Spray-Dried Proliposome Microparticles for High-Performance Aerosol Delivery Using a Monodose Powder Inhaler, AAPS PharmSciTech, Vol. 19, No. 5, 2018, pp. 2434-2448, https://doi.org/10.1208/s12249-018-1058-4.[6] T. T. H. Yen, T. T. N. Quynh, D. T. Thuan, P. T. M. Hue, Preparation of Berberin Liposomes, Contained Sodium Deoxycholate by Ethanol Injection Method, Journal of Pharmaceutical Research and Drug information, Vol. 11, No. 4, 2020, pp. 11-17 (in Vietnamese). [7] T. T. H. Yen, T. T. Hue, P. T. M. Hue et al., Preparation of Berberin Proliposomes by Film Deposition on Carrier Surface Method, VNU Journal of Science: Medical and Pharmaceutical Sciences, Vol. 36, No. 2, 2020, pp. 9-15, https://doi.org/10.25073/2588-1132/vnumps.4204.[8] R. G. Ahmed, S. Sherif, Z. Zainab et al., Silymarin Spray-Dried Proliposomes: Preparation, Characterization and Cytotoxic Evaluation, Drug Delivery Letters, Vol. 10, No. 1, 2020, pp. 14-23, https://doi.org/10.2174/2210303109666190722114211.[9] A. Bangham, M. M. Standish, J. C. Watkins Diffusion of Univalent Ions Across the Lamellae of Swollen Phospholipids, Journal of Molecular Biology, Vol. 13, No. 1, 1965, pp. 238-252.

A doença mão-pé-boca é uma infecção viral, normalmente benigna que afeta comumente crianças até 10 anos, causada pelos enterovírus humano. O propósito deste estudo foi revisar os aspectos da doença que se faz presente nos dias atuais abordando a etiologia, epidemiologia, surtos, sintomatologia e comorbidades, diagnóstico, prevenção e tratamento. Foram selecionadas publicações em periódicos referenciados nas fontes de dados do Google Acadêmico, Pubmed e Periódicos Capes com as palavras chaves relacionadas ao tema desse trabalho como doença mão-pé-boca e crianças, sendo selecionados artigos produzidos até 2017. Apesar de diagnóstico clínico aparentemente simples, a doença pode ser confundida com outras enfermidades por suas características semelhantes, que podem induzir o colega odontólogo ao equívoco de diagnóstico.Descritores: Doença de Mão, Pé e Boca; Diagnóstico, Odontopediatria.ReferênciasSarkar PK, Sarker NK, Tayab A. Hand, foot and mouth disease (hfmd):an update. 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Int J Infect Dis. 2010;14:e1076-81.Wang J, Hu T, Sun D, Ding S, Carr M, Xin W, et al. Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009-2016. Sci Rep.2017;7(1):1-9.He SZ, Chen MY, Xu XR, Yan Q, Niu JJ, Wu WH et al. Epidemics and aetiology of hand, foot and mouth disease in Xiamen, China, from 2008 to 2015. Epidemiol Infect. 2017;145:1865-74.Dantas A, Oliveira MJ, Lourenço O, Coelho PB. Doença mão-pé-boca no adulto - a propósito de um caso clínico. Rev Port Med Geral Farm. 2013;29:62-5.Chatproedprai S, Theanboonlers A, Korkong S, Thongmee C, Wananukul S, Poovorawan. Clinical and molecular characterization of hand-foot-and-mouth disease in thailand, 2008-2009. J Infect Dis. 2010;63:229-233.Zhang W, Du Z, Zhang D, Yu S, Hao Y. Quantifying the adverse effect of excessive heat on children: an elevated risk of hand, foot and mouth disease in hot days. Sci Total Environ. 2016;541:194-99.Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY et al. 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Introduction – Polish GrungeThe main objective of this article is to examine the grunge scene of the 1990s in Poland in the context of acculturation and assimilation processes. Polish grunge was, on the one hand, the expression of trends that were observable in music industry since the late 1980s. On the other hand, it was symptomatic of a rapid systemic transformation. Youth culture was open for the diffusion of cultural patterns and was ready to adopt certain patterns from the West.Thus, we suggest that the local grunge scene was completely modelled on the American one: the flow of cultural practices and subcultural fashion were the manifestations of the assimilation processes in Poland, observable not only in art (i.e. rock music), but also in the domains of politics and economy, as well as in the broader social sphere. We explore how young people were ready to adopt only the surface level of the phenomenon as they were familiar with it through the media coverage it received. Young people in Poland circa the early ‘90s primarily wanted to gain access to an imaginary Western lifestyle rather than learn about real living conditions in capitalist societies, and they could do this through their involvement in grunge culture.Grunge as a Cultural PhenomenonGrunge as a popular music trend arose in the USA during the late 1980s and early 1990s, in the work of bands such as Nirvana, Pearl Jam, Stone Temple Pilots, Soundgarden, and Alice in Chains. Grunge was initially opposed to consumerism and capitalist values. Nevertheless, A&R scouts recognised the commercial potential of this music: for example, Nirvana’s Nevermind was released by Geffen Company, and Pearl Jam’s Ten by Epic. As Grzegorz Brzozowicz and Filip Łobodziński put it (313),the success of Nirvana was a post-mort triumph of punk rock and, more importantly, it indicated the potential of alternative music, which suddenly stepped outside an aesthetic ghetto and became a hot stuff. This influence was also visible as regards fashion and customs – Dr. Martens’ shoes, flannel shirts, frayed jeans, and wool caps became an outfit common for the young (…). Grunge influenced visual art, film and photography.In Poland, grunge as a subculture and sub-genre of rock music emerged in the early 1990s following the international commercial success of bands such as those listed above, and it entailed the assimilation of the Western cultural patterns. Although assimilation processes were typical primarily for youth culture, they were observed in the wider context of the changes and adaptations that Polish system underwent after the fall of the centrally planned economy and subjugation to the communist party power after the Yalta agreements (1945-1989/1990).In this context, the concept Centre/Periphery (Gopinathan, Saravanan and Altbach; Hannerz; Langholm; Pisciotta) appears as the field for the dissemination of popular culture. Popular culture is a battlefield for creating and negotiating the meanings that are inherent within cultural practices (Barker). Cultural practices play a double role in the dissemination of ideas or objects. Firstly, they come as a result of adaptation in a defined culture, and secondly, they make new cultural patterns stabile, visible, and easy to practice by people as flexible patterns of behaviour. This point is clearly visible in the context of the East European states that underwent rapid acculturation processes in which new patterns of economic and social solutions were established in centre-planned economies: the tensions of the “old” and the “new” patterns dominating in the political and social systems of those countries (e.g. Poland, the Czech Republic, Latvia, Lithuania, etc.) were visible and affected societies to a considerable degree (Pisciotta). Thus, the practices generated in cultural Centres tend to disseminate easily and to “conquer” other cultural systems, especially in the Periphery.In the case of popular culture, the flow of influences usually takes a one-dimensional form and is disseminated from the Centre to the Periphery. As Marek Jeziński (162-163) argues, both Centre and Periphery are functional systems. These systems have generated their own mythology, which separates one from another. However, as in the case of mythological systems in general, Centre and Periphery tales overlap frequently, and there are evidence that the bands that originated in the Periphery were assimilated by the Centre. For example, Nirvana and Pearl Jam were both successful in market terms and both built their own status based on the Peripheral components that were skilfully overtaken by the Centre narrative. While the Peripheral narratives are concentrated mainly on the undermining of the definition of situation and present dysfunctional character towards cultural system as such, the Centre narratives aim to maintain the definition of situation supporting mainstream values and their prevailing position in a system (Jeziński 164). Grunge is the epitome of such an implementation of cultural patterns. That is, grunge started as a fringe peripheral cultural phenomenon. The major records companies, however, recognised its potential and provided the space in the music market to support the new bands. Most of the groups in the US started as independent local acts related to independent record companies that built their status.In relation to the assimilation of grunge culture in Poland, we can distinguish two key phenomena. The first is concerned with the adaptation of general subcultural components, e.g. fashion and group identification. Here, the acculturation processes run as a primary form of mimicry, as the Polish grunge scene adopted elements typical of the grunge subculture, such as oversize sweaters, flannel shirts, Dr. Martens shoes or Converse trainers, long hair, and beanies. A newly formed subculture was different from the others popular in the 1990s. For example, punk and metal subcultures implied strong group identity, style homogeneity, rigid group limitations, and firm membership rules. Conversely, it seems that the grunge subculture was based more on a level of liquid and fragmented patchwork identity than on very inflexible group values and internal ideology or political attitudes (cf. Muggleton). Such patchwork identity formation was a result of a rapid clash between the adaptation of grunge cultural patterns from the West and the Polish economic transformation of the early 1990s.Poland underwent rapid changes that were also visible in the politics, culture and social domain, joining liberal democracies and liberal free market economies of the West. These changes resulted from a transformation of the system as a whole: from a central planned system to decentralisation of the power at both local and state levels (Sarnecki). Equally important were the changes in the political culture of Poles and their value system: they accepted the democratic changes but simultaneously, the mentality of Poles remained traditionalist (which is visible in surveys— the most important values for them were “family” and “work”), and their attitude towards the processes of cultural and institutional changes was impermanent (Garlicki; Jasińska-Kania).During the transformation, the changes were visible in the everyday lives of Polish citizens: examples include the shortages in the market that were evident after the socialist regime ended, and the easy availability of Western clothes such as jeans, shirts, denim jackets in ordinary stores. Consequently, the economic rates in the 1990s were higher in comparison to the previous decade (Bałtowski and Miszewski). Those changes resulted in a phase shift in the modernisation process, where patterns of economic and cultural development and were faster than the enculturation and socialisation processes.On the one hand, the free market allowed for almost unlimited commodification with unprecedented access to goods and services. On the other hand, the low cultural capital and economic possibilities of the citizens evolved rapidly. The communist-shaped social division fell apart, and the new class designations based of consumption/commodification patterns were established (Jeziński; Wojtkowski). Those factors resulted in high cross-generational mobility, lower entrance barriers, and higher openness indicators (cf. Polska klasa średnia; O ruchliwości społecznej w polsce).Hence, in cultural conditions based on capitalist consumption practices, the grunge subculture evolved with a commodified sense of style rather than with a firm identity. Yet, in the case of grunge style, relatively high costs of subculture commodities (e.g. Dr. Martens shoes, Converse trainers, or band t-shirts) led to DIY practices such as buying cheaper no-name shoes, and sewing badges with the names of bands and albums on jackets or backpacks.The second phenomenon encompasses the adaptation of music patterns. The Polish grunge scene was not as diversified in terms of genre variations as its US counterpart. In the beginning, the Polish grunge scene was more distressed geographically, with no specific Centre-Periphery relations. However, one of the most important bands, Hey, was established in the Northwest. When one looks at Polish grunge evolution as a ‘clash’ of American genre and the specific character of a time and place where Polish bands were recording, she or he will notice multiple similarities with the US scene.Firstly, we could name two approaches to grunge music among Polish performers: ‘intellectual’ and ‘rebel’. The ‘intellectual’ approach encompasses the group Hey. This band was established in Szczecin (the Northwest Poland), but after the success of their first album – Fire (1993), they moved to Warsaw. Hey released 11 studio records, but only the first three could be classified as “grunge” (cf. Sankowski). On the level of musical references, Fire sounds like a mixture of early Pearl Jam combined with Alice in Chains. With English lyrics and song topics that were typical for grunge— e.g., The Choice (“You’ve got a gun/You can use it now”)—similarities with Pearl Jam, in particular, are striking. The band evolved, and on their second album, Ho! (1994), Hey mixed equally Polish and English lyrics with the dynamic and specific Seattle sound (cf. Prato). Hey’s most distinctive feature comparing with other Polish grunge bands is its highly developed melodic approach to music and the poetic, sensual style of its lyrics. The third record, ? (1995), closes the band’s early stage. The next album, Karma (1997), opens the period when the amalgamation of electronics, hard rock and grunge dominated Hey’s music, with the album [sic!] (2001) representing the turning point in the group’s music style. The band suspended their work in 2017 and will probably never reunite.Over time, Hey gained one of the most dedicated audiences in Polish rock music. The music industry and critics have acknowledged Hey as one of the best Polish groups in the post-communist period. Hey has received the most nominations in the history of Fryderyki, the key Polish music awards. The group and Nosowska have won twenty-three times in multiple categories. As the longest-operating grunge-origin band in the country, Hey could be considered as a most important trend setting and scene-forming group.The more “rebellious” approach to grunge encompasses bands such as Illusion (1992-1999, 2014-present) and Houk. The former was based on the grunge and hardcore mixture of influences from Alice in Chains, Soundgarden, and Rage Against the Machine (especially in terms of rap-oriented lyrics). With the preservation of certain consistency, the band named first three albums: Illusion (1993), Illusion II (1994), and Illusion III (1995). Illusion marks the band’s aggressive style and lyrics simplicity but the studio production flattens the whole and gives an impression of a post-punk DIY venture rather than a coherent composition. The second record, however, is entirely conceptualised and thought out in terms of music and lyrics. Sharp riffs, hard rock tuning of instruments and aggressive lyrics that were focused on Polish life gave the album a needed consistency. The band’s third record is the most varied stylistically and politically engaged in their history. The harder-edged tunes from previous releases are accompanied by more psychedelic compositions (Wrona) that recall Alice in Chains’ slow songs and Layne Staley’s voice.Houk’s music similarly to other Polish grunge bands was the amalgamation of various genres and their style evolved in time. Initially, the band was regarded as an example of alternative rock music. The first album Soul Ammunition (1992) was named by music monthly Tylko Rock as a debut of the year (polskirock.art.pl). The combination of grunge, hardcore, hard rock, reggae and socio-politically engaged lyrics helped the group to establish a strong fan base. The band’s unique style was recognised internationally and Houk supported New Model Army and Bad Brains during the performances in the mid-1990’s (polskirock.art.pl). The band’s second studio release Generation X (1995) was recorded prior the multiple membership reorganizations that finally ended the grunge-orientation period of Houk’s history. One of the songs, Sleep, was dedicated to Kurt Cobain and reflected Nirvana’s approach to songwriting, which can be heard in songs such as “Lithium” (1991). Such a commemoration of Cobain’s figure is characteristic of Polish grunge culture’s establishment of strong ties with the American equivalent. Here and in many similar cases, Cobain serves not only as a grunge hero (or even a martyr) but also as a commodified pop culture figure (cf. Strong). Concerning both spheres - that is, the adaptation of grunge subculture and a development of the music scene -Polish grunge follows a different pattern to the US genre. Grunge was introduced to Poland after it was popularised and commodified by the major labels and media industry in the USA, so the adopted version was the mainstream one rather than the underground movement. Hence, the simplistic dichotomy between “underground” and “mainstream” culture does not function in terms of the Polish grunge culture, and probably is misstated even when it comes to the American phenomenon. Grunge could be perceived in Poland as both the first and the last “true” subcultural trend. At the same time, though, it was an affirmation not of ‘the rebel’ and ‘the underground’ but of capitalism and the cultural values of the West. Indeed, the Polish grunge culture couldn’t be fully aware of what grunge was warning us against while Polish society faced the rapid market and cultural transformation that allowed for its opening to Western trends.Conclusion – Is Grunge Really Dead?Although the popularity of grunge phenomenon in Poland was relatively short, the most important groups of this sub-genre - Illusion, Hey, Ahimsa, Houk, and Kr’shna Brothers - widely contributed to the emergence of the new wave of fashion for rock and hard-rock music in Poland in the mid-1990s. The most successful group of the era, Hey epitomises the transformation of grunge in Poland. Starting as a typical grunge band (modelled heavily on the US groups), they underwent a serious transition, substantially changing their music into more mainstream-oriented rock (that is, as music that was considered acceptable by rock music and AOR-focused radio stations). At the same time, grunge as a rock sub-genre underwent the contrary changes: it broke into the mainstream relatively quickly in the first half of the 1990s, establishing new rock stars of the scene (Illusion, Houk, Ahimsa, Hey), but in the late 1990s it went back to being a rock niche again. It seems that today grunge serves as a point of reference (in fact, it was an important period of rock history) for the new bands that intentionally use this sub-genre as a form of commodified, media-friendly nostalgia.ReferencesBałtowski, Maciej, Miszewski, Maciej. Transformacja gospodarcza w Polsce. 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