Abstract NCED1 (9-cis-epoxy carotenoid dioxygenase) plays important roles in controlling ABA levels and drought stress tolerance. The relationships between sequence polymorphisms of the TaNCED1 gene and drought resistance in wheat were analysed. Four allelic variations of the TaNCED1-5B generated to drought resistance were identified. Four groups of KASP (kompetitive allele-specific PCR) markers were developed based on the four alleles and were verified in a natural population of 311 wheat cultivars. The distribution of the four alleles of TaNCED1-5B in the natural population was clarified. Among the allelic variations, 84.62% of the wheat varieties with TT/-/C/-,TT/C/C/-,TT/-/C/G or TT/C/C/G haplotypes were dryland cultivars. The common feature of the above four haplotypes is that they all contain the TT (98) and C (343) alleles at the TaNCED1-5B-TT/CG (98) and TaNCED1-5B-C/T (343) loci, which indicated that these two locis had highly positive correlation with drought resistance in wheat. NCED 9cisepoxy cisepoxy 9 cis epoxy dioxygenase tolerance TaNCED analysed TaNCED15B TaNCEDB 5B B identified kompetitive allelespecific allele specific PCR 31 cultivars clarified 8462 84 62 84.62 TT//C/,TT/C/C/,TT//C/G TTCTTCCTTCG TT/ /C/ ,TT/C/C/ ,TT/ /C/G G TTCCG 98 (98 343 (343 TaNCED15BTT/CG TaNCED15BTTCG TaNCEDBTTCG TT/CG CG TaNCED15BC/T TaNCED15BCT TaNCEDBCT C/T T loci 3 846 8 6 84.6 /C TTCC ,TT/C/C ,TT (9 34 (34 TaNCED15BTT BTT BTTCG TTCG TaNCED15BC BC BCT CT 84. ( (3 TaNCEDBTT TaNCEDBC

RESUMEN Introducción El yoga, originario de la cuenca del río Indo, es una técnica ancestral que implica habilidades físicas o ejercicio aeróbico estático. Objetivo Comprobar y analizar los cambios en la forma física de los adolescentes sometidos a un experimento de yoga. Métodos En la elaboración de este artículo se utilizaron el método experimental, la revisión bibliográfica, la estadística matemática y otros métodos de investigación. Se seleccionó a 30 estudiantes de primer año de educación primaria de la Universidad Normal de Yancheng para una formación en enseñanza del yoga de 12 semanas con el fin de explorar el impacto del yoga en la salud y la forma física de los estudiantes universitarios ordinarios. Resultados El índice de grasa corporal y el índice de masa grasa disminuyeron, el volumen pulmonar aumentó significativamente y la forma física aumentó significativamente. Conclusión Tras 12 semanas de ejercicios de yoga, la composición corporal de los estudiantes universitarios evaluados mejoró significativamente, aumentando tanto la flexibilidad como la forma física. También fueron notables los cambios observados en la capacidad de equilibrio y la capacidad de respuesta, lo que revela una mejora intrínseca en la musculatura esquelética de los alumnos. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento. Indo estático experimental bibliográfica 3 1 ordinarios disminuyeron respuesta alumnos II tratamiento

ABSTRACT Introduction Yoga originated in the Indus River basin, is an ancient technique involving physical skills or static aerobic exercise. Objective Test and analyze the changes in physical fitness of adolescents submitted to yoga experiment. Methods Experimental method, literature review, mathematical statistics and other research methods were used in making this paper. 30 freshmen in primary education at Yancheng Normal University were selected for a 12-week yoga teaching training to explore the impact of yoga on health and physical fitness of ordinary college students. Results Body fat rate and fat mass index decreased, lung volume increased significantly, and physical fitness increased significantly. Conclusion After 12 weeks of yoga exercises, the body composition of the tested college students improved significantly, increasing both flexibility and physical fitness. Notable changes were also seen in balance and responsiveness, revealing an intrinsic improvement in the students’ skeletal muscles. Level of evidence II; Therapeutic studies - investigation of treatment outcomes. basin exercise experiment method review paper 3 12week week decreased significantly 1 exercises responsiveness muscles II outcomes

RESUMO Introdução A ioga, originada na bacia do rio Indo, é uma técnica antiga que envolve habilidades físicas ou exercício aeróbico estático. Objetivo Testar e analisar as alterações na aptidão física de adolescentes submetidos ao experimento de ioga. Métodos Foram utilizados na confecção deste artigo o método experimental, revisão bibliográfica, estatística matemática e outros métodos de pesquisa. 30 calouros na educação primária da Universidade Normal de Yancheng foram selecionados para um treinamento de 12 semanas de ensino de ioga para explorar o impacto da yoga na saúde e na aptidão física de estudantes universitários comuns. Resultados A taxa de gordura corporal e o índice de massa gorda diminuiu, o volume pulmonar aumentou significativamente, e a aptidão física aumentou significativamente. Conclusão Após 12 semanas de exercícios de ioga, a composição corporal dos estudantes universitários testados melhorou significativamente, elevando tanto a flexibilidade quanto a aptidão física. Notáveis também foram as alterações constatadas na capacidade de equilíbrio e a capacidade de reação, revelando uma melhora intrínseca na musculatura esquelética dos estudantes. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento. Indo estático experimental bibliográfica pesquisa 3 1 comuns diminuiu significativamente reação II tratamento

ABSTRACT Purpose: To observe the mechanism of prepared Radix Rehmanniainon combined with Radix Astragali in treating osteoporosis. Methods: Osteoporosis rat model was established by bilateral ovariectomy combined with low-calcium diet feeding. Bone mineral density was measured by bone densitometer. Bone metabolism markers in serum were detected by enzyme linked immunosorbent assay (ELISA), bone tissue structure was observed by hematoxylin-eosin staining, and the effect of prepared Radix Rehmanniainon combined with Radix Astragali on PI3K-AKT signaling pathway was investigated by immunohistochemistry and reverse transcription polymerase chain reaction. Results: Compared with the model group, the bone tissue structure and imbalance of bone metabolism were improved, and the bone mineral density was significantly increased in the prepared Radix Rehmanniainon combined with Radix Astragali groups. After intervention with prepared Radix Rehmanniainon combined with Radix Astragali, the positive expression of PIK3CA and Akt1 in rat bone tissue was enhanced, and the expression levels of Akt1 mRNA were significantly increased. Conclusions: Prepared Radix Rehmanniainon combined with Radix Astragali may treat osteoporosis by activating PI3K/AKT pathway. Purpose Methods lowcalcium low calcium feeding densitometer ELISA, ELISA , (ELISA) hematoxylineosin hematoxylin eosin staining PI3KAKT PIKAKT PI3K AKT PI K reaction Results group improved groups PIKCA PIK CA Akt enhanced Conclusions (ELISA KAKT

Abstract Objectives Diabetes has been strongly associated with periodontal diseases. The periodontal ligament (PDL) has an abundant extracellular matrix (ECM). Lysyl oxidases (LOXs) are closely associated with various diseases caused by abnormal ECM functions, however, the role of LOXs in periodontal diseases induced by diabetes remains unclear. Methodology In this study, 8-week-old Zucker diabetic fatty rats were used to establish a type 2 diabetes mellitus (T2DM) model. After 9 and 16 weeks, hematoxylin and eosin (H&E), Masson’s trichrome, and immunohistochemical staining were performed. Results After 9 weeks, loose collagen fibers were found in the interradicular area of the diabetic group, in opposition to the control group. There were no significant differences in LOX expression between the diabetic and control groups (p>0.05). However, after 16 weeks, the diabetic group presented a disordered arrangement of the PDL, showing decreased collagen content and significantly increased lysyl oxidase-like protein 3 (LOXL3) expression when compared with the control group (p<0.05). This suggests that LOXL3 plays a significant role in periodontal histopathological changes in diabetic rats. Conclusion Our study showed elevated LOXL3 expression in the PDL of diabetic rats after 16 weeks, suggesting that LOXL3 may be involved in the occurrence and development of periodontal histopathological changes in diabetic rats. LOXL3 could be further used as an indicator for the early diagnosis of diabetic periodontitis in T2DM patients in clinical settings.

Abstract Objective: The objective was to evaluate whether initiation of urate-lowering treatment (ULT) during an acute gout flare prolonged the current episode. Methods: A comprehensive search of MEDLINE and Web of Science databases was conducted from their inception to 15 March 2021. Five randomized controlled trials (RCTs) with 381 patients met the inclusion criteria. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were used for estimating the clinical efficacy of ULT in acute gout. Results: There was no statistical difference in days to resolution (intent-to-treat analysis) (SMD, 0.68; 95% CI — 0.42 to 1.78; I2, 49%; p = 0.22), the pain visual analogue score (VAS) by day 10 (SMD, — 0.07; 95% CI — 0.30 to 0.16; I2, 0%; p = 0.53), C-reactive protein (CRP) from day 7 to 10 (SMD, — 1.14; 95% CI — 5.63 to 3.36; I2, 55%; p = 0.62), erythrocyte sedimentation rate (ESR) from day 7 to 10 (SMD, — 2.51; 95% CI — 5.46 to 0.45; I2, 0%; p = 0.10) and the recurrence of gout flares within 28-30 days (OR 0.78; 95% CI 0.29 to 2.09; I2, 0%; p = 0.62). Conclusion: Initiation of ULT during an acute gout flare did not prolong the duration of the flare. However, larger sample size studies are needed to confirm this finding. Trial registration number PROSPERO (CRD42021234581).

ABSTRACT Purpose: Spontaneous intracerebral hemorrhage (ICH) is a major public health problem with a huge economic burden worldwide. Ulinastatin (UTI), a serine protease inhibitor, has been reported to be anti-inflammatory, immune regulation, and organ protection by reducing reactive oxygen species production, and inflammation. Necroptosis is a programmed cell death mechanism that plays a vital role in neuronal cell death after ICH. However, the neuroprotection of UTI in ICH has not been confirmed, and the potential mechanism is unclear. The present study aimed to investigate the neuroprotection and potential molecular mechanisms of UTI in ICH-induced EBI in a C57BL/6 mouse model. Methods: The neurological score, brain water content, neuroinflammatory cytokine levels, and neuronal damage were evaluated. The anti-inflammation effectiveness of UTI in ICH patients also was evaluated. Results: UTI treatment markedly increased the neurological score, alleviate the brain edema, decreased the inflammatory cytokine TNF-α, interleukin‑1β (IL‑1β), IL‑6, NF‑κB levels, and RIP1/RIP3, which indicated that UTI-mediated inhibition of neuroinflammation, and necroptosis alleviated neuronal damage after ICH. UTI also can decrease the inflammatory cytokine of ICH patients. The neuroprotective capacity of UTI is partly dependent on the MAPK/NF-κB signaling pathway. Conclusions: UTI improves neurological outcomes in mice and reduces neuronal death by protecting against neural neuroinflammation, and necroptosis.

Abstract Osmotic dehydration is a nonthermal processing technology, that is limited in blueberries because of the osmotic agent, temperature and efficiency. This study was to prepare a novel ternary solution considering low-sugar, low-salt and low-viscosity requirements and to dehydrate blueberries at 20 °C. The mass transfer kinetics of fresh and frozen blueberries were explored in ternary solution considering the volume shrinkage of blueberries. The results showed that the 40%/50% xylitol solution had the lowest viscosity in polyols at 20 °C. The addition of 5%/10% CaCl2 had no significant effect on the viscosity of the ternary solution. Frozen blueberries had higher OD efficiency and less equilibrium time than fresh blueberries at 600 rpm vibration speed and 50%xylitol/10%CaCl2 concentration. There was competition between xylitol and CaCl2 transfer at shorter dehydration times for fresh blueberries, which was not significant in frozen blueberries and with longer times. Considering volume shrinkage of the blueberries, the effective diffusion coefficient of water and solute was calculated. The vibration speed had a significant effect on the effective diffusion coefficient, which governed the mass transfer efficiencies of the blueberries in the ternary solution.

ABSTRACT Purpose To study effects of Rehmannia glutinosa polysaccharides (RGP) on bone tissue structure and skeletal muscle atrophy in rats with disuse. Methods A rat model of disuse osteoporosis combined with muscle atrophy was established by removing the bilateral ovaries of rats and fixing their hind limbs for a long time. Forty SD rats were administered intragastrically for 12 weeks. The bone histomorphometry parameters and the level of oxidative stress were measured. In addition, the changes of muscle atrophy F-box (MAFbx), muscle RING-finger protein-1 (MuRF1), forkhead box O1 (FOXO1) mRNA expression in skeletal muscle of rats were observed. Results RGP significantly increased the percentage of fluorescence perimeter and bone mineralization deposition rate of the second lumbar vertebrae of rats. It also significantly increased the wet weight ratio and muscle fiber cross-sectional area of the gastrocnemius muscle of rats. At the same time, RGP significantly increased the levels of super oxide dismutase (SOD) and catalase (CAT) in the skeletal muscle of rats, and reduced the content of malondialdehyde (MDA). Rehmannia glutinosa polysaccharides also significantly reduced the expression levels of FOXO1, MAFbx and MuRF1 mRNA in rat skeletal muscle. Conclusions RGP could improve the bone structure of osteoporotic rats. It could also improve muscle that atrophy may be related to the inhibition of FOXO1-mediated ubiquitin-proteasome pathway.

Abstract Cordyceps militaris is a commonly used edible and medicinal fungus in East Asia. Preparation of the mycelium and fermentation liquid by submerged fermentation using additives such as Panax ginseng for skin whitening applications has attracted wide attention. In the present study, we screened traditional Chinese medicines as additives to the liquid fermentation medium for C. militaris and performed systematical research on the changes of bioactivity and ginsenoside levels during the fermentation process. Total polysaccharide contents, cordycepin content, and polysaccharide molecular weight in the fermentation products were measured by UV spectrophotometry, high-performance liquid chromatography-diode array detection (HPLC/DAD), and gel permeation chromatography-multi angle laser light scattering (GPC-MALLS), respectively. In addition, the ginsenosides Rb1, Re, Rd, Rg1, and pseudoginsenoside F11 in the fermentation products were quantitatively analyzed by ultra-performance liquid chromatography/tandem mass spectrometry (UPLC/MS/MS). Panax ginseng significantly increased the cordycepin and total sugar contents, and the average molecular weight of polysaccharides in the fermentation liquid and the mycelium of C. militaris. At the same time, C. militaris enhanced the production of ginsenoside pseudoginsenoside F11, which is a unique component of Panax quinquefolium. The research provides scientific evidence for the application of C. militaris and P. ginseng as raw materials for food and medicines.

Abstract Ginkgo biloba leaves are commonly used in traditional Chinese medicine. Owing to its wide distribution across China with varying geographical environments and climatic characteristics, G. biloba leaf products have different active ingredients and degrees of activities, which poses a challenge for quality control and standardization. We aimed to identify the key factors contributing to the quality of G. biloba based on assessment of anti-aging and antioxidative components. G. biloba leaf samples collected from 14 different regions in China were analyzed for antioxidant activities by the 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) free radical scavenging assay, and the levels of terpene lactones and flavonoids were quantified by ultra-performance liquid chromatography-tandem mass spectroscopy and high performance liquid chromatography. Correlation analysis attributed the antioxidant activity of G. biloba leaf samples of different origins to isoginkgetin and ginkgetin, which also affected the matrix metalloproteinase-1 levels of fibroblasts, determined using enzyme-linked immunosorbent assay and reverse transcription-polymerase chain reaction. Therefore, appropriate quality control of a collected G. biloba sample could be achieved by determining the levels of isoginkgetin and ginkgetin as anti-aging and antioxidant components. The results further provide a foundation for the application of G. biloba leaves as an antioxidant raw material.

The etiology of polycystic ovary syndrome (PCOS) is complex and the pathogenesis is not fully understood. Some studies have shown that dysregulation of ovarian granulosa cells may be related to abnormal follicles and excessive androgen in women with PCOS. Our team has also confirmed the high expression status of H19 in PCOS patients in the early stage. However, the relationship between H19 and miR-19b in the development of PCOS is still unknown. Therefore, we used bioinformatics to predict the binding sites of human H19 and miR-19b, and of miR-19b and CTGF genes. After the silencing and overexpression of H19, real-time polymerase chain reaction (PCR) was used to detect the expressions of H19, miR-19b, and CTGF. Western blotting was used to detect CTGF protein. Proliferation of KGN cells after H19 silencing was detected by CCK8. Flow cytometry was used to detect the apoptosis of KGN cells after H19 silencing. After the overexpression of H19, it was found that the expression of miR-19b gene decreased and the expression of CTGF increased, whereas silencing of H19 did the opposite. In addition, H19 could promote cell proliferation and decrease cell apoptosis. Finally, luciferase reporter assays showed that the 3′-end sequences of lncRNA H19 and CTGF contained the binding site of miR-19b. In conclusion, our study indicated that lncRNA H19 acted as a ceRNA to bind to miR-19b via a “sponge” to regulate the effect of CTGF on KGN cells, which may play a vital role in PCOS.

RESUMO Contexto A educação médica assíncrona via web, em Ambientes de Aprendizagem Virtual (AVA), cresceu muito, em virtude de suas diversas vantagens. Há várias configurações e métodos de instrução disponíveis. As propostas existentes são pouco estruturadas e/ou não são efetivamente utilizadas para o ensino de habilidades de diagnóstico para estudantes de graduação em Medicina, no Brasil. É necessário um método instrutivo robusto, com características pedagógicas positivas. Assim, propomos um método pedagogicamente estruturado para AVA, que inclui uma leitura inicial motivadora (Crônica Médica – CM) e um programa de construção de conhecimento, utilizando casos reais juntamente com recursos audiovisuais (Oficina Diagnóstica – OD). Objetivamos verificar a aceitação e a eficácia do método proposto na melhoria da capacidade diagnóstica dos estudantes de Medicina, em longo prazo. Métodos Foi desenvolvido um questionário de opiniões, dois materiais CM/OD e dois questionários de Conhecimento e Habilidades Diagnósticas (CHD) sobre acidente vascular encefálico e epilepsia. Dois grupos de estudantes de Medicina foram acompanhados neste estudo observacional longitudinal, em 2013. Os alunos responderam ao CHD1 e participaram de uma aula teórica tradicional, sobre um dos tópicos. Eles também acessaram um AVA para realizar o método CM/OD sobre um dos dois temas. O mesmo questionário (CHD2 e CHD3) foi aplicado, respectivamente, um mês e cinco-seis meses após o CHD1. Analisamos a média CHD1 de todos os alunos e as médias pareadas nos três momentos, dos que acessaram e daqueles que não acessaram o AVA. O questionário de opiniões foi aplicado e analisado por estatística descritiva. Resultados Oitenta e sete alunos participaram, mas seis foram excluídos por não responderem a todos os questionários. A média geral do CHD1 foi de 1,59 (desvio-padrão 0,71). Dos 81 participantes, 66 (81,5%) acessaram o AVA, mostrando melhora significativa nas habilidades de diagnóstico no CHD2 (média 5,65, p <0,05) e CHD3 (média 4,57, p < 0,05), com variações não significativas para aqueles que não acessaram. A CM foi considerada pelo menos boa para 62 alunos (94%), e 52 alunos (78,8%) julgaram que o gabarito disponível foi suficiente para sanar todas as dúvidas da OD. Conclusões O método CM/OD no AVA provou ser eficaz para melhorar a capacidade de diagnóstico dos estudantes de graduação em Medicina, em longo prazo, e foi bem aceito pelos alunos. Ele apresenta várias características pedagógicas positivas e pode ser replicado.

ABSTRACT Background Asynchronous Web-based Medical Education in Virtual Learning Environments (VLEs) has grown steadily because of its many advantages. Various configurations and instructional methods are presently available. The existing proposals are poorly structured and/or not very effectively used for teaching diagnostic skills to undergraduate medical students in Brazil. A robust instructional method with positive pedagogical characteristics is needed. Thus, we have proposed a pedagogically-structured method for VLEs that includes a motivating initial reading (Medical Chronicle – MC), and a knowledge building program, using real cases coupled with audiovisual resources (Diagnostic Workshop – DW). We aimed to verify its acceptance, as well as the efficacy of the MC/DW method in improving the diagnostic ability of medical students, in the long term. Methods An opinion survey, two MC/DW materials and two Knowledge and Diagnostic Skills (KDS) questionnaires on stroke and epilepsy were developed, and two medical student groups were followed up in this 2013 longitudinal observational study. The students answered a KDS1, and attended a traditional lecture on one of the topics. They also accessed a VLE to apply the MC/DW method on stroke or epilepsy. We applied the same questionnaire (KDS2 and KDS3, respectively), one month and 5-6 months after the KDS1. We analyzed the mean KDS1 score of all the students, and the mean pairwise of those who accessed and those who did not access the VLEs during these three stages. An opinion survey was applied, and the results were analyzed by descriptive statistics. Results 87 students participated in the study, but six were excluded as they did not answer the questionnaires. The KDS1 general mean score was 1.59 (SD0.71). We found that 66 students (81.5%) accessed the VLE, showing a significant improvement in diagnostic skills in the KDS2 (mean5.65, p<0.05) and KDS3 (mean 4.57, p<0.05), with non-significant variations for those who did not access it. The MC was considered at least good for 62 students (94%), with 52 students (78.8%) finding that a checklist was sufficient to clear up all their DW doubts. Conclusions The MC/DW method in VLE proved to be effective for improving the diagnostic capability of the undergraduate medical students in the long term, and it was well accepted by the students. It presents several positive pedagogical characteristics and can be replicated.

RESUMO Objetivo: identificar e eliminar as etapas que não agregam valor ao cliente na central de desinfecção. Método: foi aplicada a ferramenta Lean: Mapa de Fluxo de Valor, utilizando os conceitos Gemba e Kaizen no processo de trabalho da unidade de desinfecção de materiais para uso na assistência ventilatória com o intuito de melhorar o processo de trabalho. Foi realizada a capacitação da equipe em relação aos conceitos Lean descritos acima, foi aplicado o Mapa de Fluxo de Valor no Gemba, foram analisadas as oportunidades de melhoria e, após, aprovação das alterações, foi desenhado o Mapa de Fluxo de Valor do estado futuro e implementadas as mudanças. Resultado: obteve-se redução de tempo em 2h37 no processo de desinfecção e redução de recursos financeiros em R$ 809,08 reais/mês. Conclusão: a aplicação de conceitos Lean apresentou resultados positivos na eliminação de desperdícios na central de desinfecção.

ABSTRACT Objective: To identify and eliminate steps that do not add value for customers in the disinfection center. Method: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. Result: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. Conclusion: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.

RESUMEN Objetivo: identificar y eliminar los pasos que no agregan valor para los clientes en el centro de desinfección. Método: aplicamos la herramienta Lean: mapa de la cadena de valor, conceptos de gemba y kaizen, en el proceso de trabajo de la unidad de desinfección para materiales de asistencia ventilatoria con el objetivo de mejorar el proceso. Después de realizar una capacitación con el equipo sobre los conceptos Lean descritos anteriormente, aplicamos el Mapa de la cadena de valor en el gemba, analizamos las oportunidades de mejora y aprobamos los cambios; se diseñó el Mapa de la cadena de valor del estado futuro y se implementaron los cambios. Resultado: el tiempo del proceso de desinfección se redujo en dos horas y treinta y siete minutos, y los recursos financieros requeridos también disminuyeron en R$ 809,08/mes. Conclusión: la aplicación de los conceptos Lean presentó resultados positivos para la eliminación de desperdicios en el centro de desinfección.

ABSTRACT Objective: To identify and eliminate steps that do not add value for customers in the disinfection center. Method: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. Result: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. Conclusion: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.

RESUMEN Objetivo: identificar y eliminar los pasos que no agregan valor para los clientes en el centro de desinfección. Método: aplicamos la herramienta Lean: mapa de la cadena de valor, conceptos de gemba y kaizen, en el proceso de trabajo de la unidad de desinfección para materiales de asistencia ventilatoria con el objetivo de mejorar el proceso. Después de realizar una capacitación con el equipo sobre los conceptos Lean descritos anteriormente, aplicamos el Mapa de la cadena de valor en el gemba, analizamos las oportunidades de mejora y aprobamos los cambios; se diseñó el Mapa de la cadena de valor del estado futuro y se implementaron los cambios. Resultado: el tiempo del proceso de desinfección se redujo en dos horas y treinta y siete minutos, y los recursos financieros requeridos también disminuyeron en R$ 809,08/mes. Conclusión: la aplicación de los conceptos Lean presentó resultados positivos para la eliminación de desperdicios en el centro de desinfección.

RESUMO Objetivo: identificar e eliminar as etapas que não agregam valor ao cliente na central de desinfecção. Método: foi aplicada a ferramenta Lean: Mapa de Fluxo de Valor, utilizando os conceitos Gemba e Kaizen no processo de trabalho da unidade de desinfecção de materiais para uso na assistência ventilatória com o intuito de melhorar o processo de trabalho. Foi realizada a capacitação da equipe em relação aos conceitos Lean descritos acima, foi aplicado o Mapa de Fluxo de Valor no Gemba, foram analisadas as oportunidades de melhoria e, após, aprovação das alterações, foi desenhado o Mapa de Fluxo de Valor do estado futuro e implementadas as mudanças. Resultado: obteve-se redução de tempo em 2h37 no processo de desinfecção e redução de recursos financeiros em R$ 809,08 reais/mês. Conclusão: a aplicação de conceitos Lean apresentou resultados positivos na eliminação de desperdícios na central de desinfecção.

RESUMO Racional: As características clínicas são fundamentais para melhorar a identificação e o tratamento da doença de Crohn (DC), de modo que a análise da amostra seja de grande valor. Objetivo: Explorar as características clínicas da DC fistulizante perianal. Métodos: Análise de 139 casos focados em seus dados clínicos. Resultados: A proporção de homens e mulheres foi de 3,3: 1; a média de idade de 28,2 anos; 47,5% dos pacientes tiveram fístula anal antes do diagnóstico de DC. Pacientes com cirurgia perianal prévia e medicação representaram 64,7% e 74,1%, respectivamente. O tipo de lesão L3 estava presente em 49,6% e os tipos B1 e B2, em 51,8% e 48,2%, respectivamente; fístula anal complexa foi diagnosticada em 90,6%. Sintomas de diarréia foram encontrados em 46% e lesões perianais isoladas em 29,5% dos pacientes. Valores anormais de IMC estavam presentes em 44,6%; índice de atividade DC ativa em 64,7%; e 94,2% tinham índice de atividade de doença perianal ativo. Proporção significativa de pacientes tinha proteína-C reativa, taxa de sedimenta do eritrócito, plaquetas hemoglobina e albumina anormais. Conclusão: Sugere-se que pacientes com fístula anal associada às essas características clínicas alertem a equipe médica para a possibilidade de DC, que deve ser investigada por endoscopia e exame de imagem do trato digestivo para evitar dano na função anal pela operação que rotineiramente é realizada no tratamento da fístula anal.

ABSTRACT Background: Clinical characteristics are keys to improve identification and treatment of Crohn´s disease (CD) so that large sample analysis is of great value. Aim: To explore the clinical characteristics of perianal fistulising CD. Methods: Analysis of 139 cases focused on their clinical data. Results: The proportion of males and females is 3.3:1; the mean age is 28.2 years; 47.5% of patients had anal fistula before CD diagnosis. Patients with prior perianal surgery and medication accounted for 64.7% and 74.1% respectively. The L3 type of lesion was present in 49.6% and the B1 and B2 types for 51.8% and 48.2% respectively; complex anal fistula was diagnosed in 90.6%. Symptoms of diarrhea were found in 46% and perianal lesions alone in 29.5% of patients. Abnormal BMI values was present in 44.6%; active CD activity index in 64.7%; and 94.2% had active perianal disease activity index. A proportion of patients manifest abnormal C-reactive protein, erythrocyte sedimentation rate, platelet, hemoglobin and albumin. Conclusion: We suggest that patients with anal fistula associated to these clinical features should alert the medical team to the possibility of CD, which should be further investigated through endoscopy and imaging examination of alimentary tract to avoid the damage of anal function by routine anal fistula surgery.