PSCPF: planning, scheduling and control of patient flow

Paper aims: Lack of operational planning in healthcare organizations may result in service disconnection and reduced value per effort to the patient. Production Planning, Scheduling and Control assists in determining “what,” “how much,”= “when” and “where” to deliver, which may be of great relevance to healthcare services. This study proposes a structural framework and analyzes the implementation of PPSC concepts in OR management. Originality: The application of concepts from manufacturing applied to healthcare as the PPSC, present in this text, demonstrates the crossing and alignment of global management techniques and tools applicable to both areas. Research method: The discussion is based on data gathered through action-research in a Brazilian public hospital. Main findings: In the hospital under study, the PSCPF implementation resulted in increased production control of surgeries, increased efficiency in management of waiting lists, increased operational efficiency, and motivational gains from staff integration. Implications for theory and practice: The understanding and proper implementation of the concept of PPSC contributed =to mitigate problems related to capacity management, reduced the unawareness of different levels of demand and waiting lists, cut down scheduling errors, and prevented the provision of false information from the disconnection between the various areas of the hospital.- (undefined

Comparison of blood neoangiogenesis and lymphatic vascularization in colorectal adenomas from patients with and without concomitant colorectal cancer

Blood and lymphatic vessel proliferation is essential for tumor growth and progression. Most colorectal carcinomas develop from adenomas (adenoma-carcinoma sequence) in a process due to accumulation of molecular genetic alterations. About 5% of adenomatous polyps are expected to become malignant, but data on the differential angiogenic patterns of these lesions in patients with and without concomitant cancer are missing. The aim of the present study is to compare the angiogenic and lymphatic patterns of adenomatous polyps from patients with and without sporadic cancer. Thirty adenomatous polyps (15 from patients with another principal malignant lesion, and 15 from patients without cancer) were submitted to immunohistochemical staining for CD105 (marker for neoangiogenesis) and D2-40 (marker for lymphatic endothelium). Microvessel density and total vascular area were determined by computer image analysis to quantify the immunostained and total areas, and to assess the number of microvessels. Adenomas from patients with carcinoma showed significantly higher values of total vascular area determined by immunostaining for CD105 (cutoff value = 4386 µm²; P = 0.019) and of lymphatic microvessel density determined by immunostaining with D2-40 (cutoff value = 11.5; P = 0.041) when compared with those from patients without cancer. The present data indicate a significant increase in blood microvascular area and in lymphatic microvascular counts in adenomas removed from patients with cancer.59359

Cissus Sicyoides: Pharmacological Mechanisms Involved In The Anti-inflammatory And Antidiarrheal Activities

The objective of this study was to evaluate the pharmacological mechanisms involved in anti-inflammatory and antidiarrheal actions of hydroalcoholic extract obtained from the leaves of Cissus sicyoides (HECS). The anti-inflammatory effect was evaluated by oral administration of HECS against acute model of edema induced by xylene, and the mechanisms of action were analysed by involvement of arachidonic acid (AA) and prostaglandin E2 (PGE2). The antidiarrheal effect of HECS was observed and we analyzed the motility and accumulation of intestinal fluid. We also analyzed the antidiarrheal mechanisms of action of HECS by evaluating the role of the opioid receptor, α2 adrenergic receptor, muscarinic receptor, nitric oxide (NO) and PGE2. The oral administration of HECS inhibited the edema induced by xylene and AA and was also able to significantly decrease the levels of PGE2. The extract also exhibited significant anti-diarrheal activity by reducing motility and intestinal fluid accumulation. This extract significantly reduced intestinal transit stimulated by muscarinic agonist and intestinal secretion induced by PGE2. Our data demonstrate that the mechanism of action involved in the anti-inflammatory effect of HECS is related to PGE2. The antidiarrheal effect of this extract may be mediated by inhibition of contraction by acting on the intestinal smoothmuscle and/or intestinal transit. © 2016 by the authors; licensee MDPI, Basel, Switzerland.17

Interaction between ascorbic acid and follicle-stimulating hormone maintains follicular viability after long-term in vitro culture of caprine preantral follicles

This study evaluates the effects of ascorbic acid and its interaction with follicle-stimulating hormone (FSH) on the morphology, activation, and in vitro growth of caprine preantral follicles. Ovarian fragments were cultured for 1, 7, or 14 d in minimum essential medium (MEM) containing ascorbic acid (50 or 100 μg/mL), FSH (50 ng/mL), or both of these substances. Ovarian tissue that was either fresh (control) or cultured for 1, 7, or 14 d was processed for histological and ultrastructural evaluation. The results showed that after 14 d of culture, medium supplemented with 50 μg/mL of ascorbic acid alone or combined with FSH showed higher rates of follicular survival compared with MEM. After 7 d of culture, FSH, ascorbic acid at 50 μg/mL with or without FSH, and ascorbic acid at 100 μg/mL increased the percentage of follicular activation compared to fresh control. In addition, FSH alone significantly increased the percentage of growing follicles after 14 d. The combination of 50 μg/mL of ascorbic acid and FSH promoted a significant increase in oocyte and follicular diameter after 7 d of culture. Ultrastructural and fluorescent analysis confirmed the integrity of follicles cultured with 50 μg/mL of ascorbic acid and FSH after 14 d. In conclusion, the combination of 50 μg/mL of ascorbic acid and FSH maintained follicular integrity and promoted follicular activation and growth after long-term in vitro culture of caprine preantral follicles

Inhalation of the prodrug PI3K inhibitor CL27c improves lung function in asthma and fibrosis

PI3K activation plays a central role in the development of pulmonary inflammation and tissue remodeling. PI3K inhibitors may thus offer an improved therapeutic opportunity to treat non-resolving lung inflammation but their action is limited by unwanted on-target systemic toxicity. Here we present CL27c, a prodrug pan-PI3K inhibitor designed for local therapy, and investigate whether inhaled CL27c is effective in asthma and pulmonary fibrosis. Mice inhaling CL27c show reduced insulin-evoked Akt phosphorylation in lungs, but no change in other tissues and no increase in blood glycaemia, in line with a local action. In murine models of acute or glucocorticoid-resistant neutrophilic asthma, inhaled CL27c reduces inflammation and improves lung function. Finally, inhaled CL27c administered in a therapeutic setting protects from bleomycin-induced lung fibrosis, ultimately leading to significantly improved survival. Therefore, local delivery of a pan-PI3K inhibitor prodrug reduces systemic on-target side effects but effectively treats asthma and irreversible pulmonary fibrosis

Zinc deficiency disrupts pain signaling promoting nociceptive but not inflammatory pain in mice

Abstract Zinc (Zn) is an essential micronutrient involved in the physiology of nervous system and pain modulation. There is little evidence for the role of nutritional Zn alternations to the onset and progression of neuropathic (NP) and inflammatory pain. The study investigated the effects of a zinc restricted diet on the development of pain. Weaned mice were submitted to a regular (38 mg/kg of Zn) or Zn deficient (11 mg/kg of Zn) diets for four weeks, pain responses evaluated (mechanical, cold and heat allodynia; formalin- and carrageenan-induced inflammatory hypernociception), plasma and tissues collected for biochemical and metabolomic analysis. Zn deficient diet inhibited animal growth (37%) and changed mice sensitivity pattern, inducing an intense allodynia evoked by mechanical, cold and heat stimulus for four weeks. The inflammatory pain behavior of formalin test was drastically reduced or absent when challenged by an inflammatory stimulus. Zn restriction also reduce plasma TNF, increase neuronal activation, oxidative stress, indicating a disruption of the immune response. Liver metabolomic analyses suggest a downregulation of lipid metabolism of arachidonic acid. Zn restriction since weaned disrupts pain signaling considerably and reduce inflammatory pain. Zn could be considered a predisposing factor for the onset of chronic pain such as painful neuropathies

Echinoderms from Todos os Santos Bay and Aratu Bay (Bahia, Brazil)

Neste trabalho são registrados os equinodermos (exceto Holothuroidea) obtidos durante a execução do projeto "Marine Environmental Evaluation of the Todos os Santos Bay-MAREMBA" em julho/agosto de 1996 e durante o projeto "Geoecologia das comunidades bentônicas infralitorais da Baía de Todos os Santos (BTS), BA, Brasil: diversidade biótica e sedimentológica", (1997). Um total de 33 espécies pertencentes a 15 famílias foram registradas e re-descritas. A distribuição de Ophiactis brasiliensis Manso, 1988 e Amphiodia trychna H.L. Clark, 1918 é estendida para a região nordeste do Brasil. A classe Ophiuroidea foi dominante nas amostragens em termos de abundância e freqüência de ocorrência, em particular as espécies Amphiodia atra Stimpson, 1852, Amphipholis subtilis (Ljungman, 1867), Ophiactislymani Ljungman, 1871 e Ophiostigma isocanthum (Say, 1825). O asteróide Oreaster reticulatus (Linnaeus, 1758) é considerado vulnerável à exploração humana e foi escasso durante as coletas. Outras espécies encontradas na BTS, tais como os asteroides Luidia clathrata (Say, 1825) e L. senegalensis (Lamarck, 1816) e o equinóide Eucidaristribuloides (Lamarck, 1816) figuram na lista nacional de espécies de invertebrados aquáticos ameaçados de extinção._______________________________________________________________________________ ABSTRACT: We present the results of the studies on biodiversity of Echinodermata (except Holothuroidea) from the Projects "Marine Environmental Evaluation of the Todos os Santos Bay - MAREMBA" (July/August 1996) and "Geoecology of the Benthic Infralitoral Communities of Todos os Santos Bay (BTS), Bahia, Brazil" (1997). A total of 33 species from 15 families were registered and re-described. The distribution of Ophiactis brasiliensis Manso, 1988 and Amphiodia trychna H.L. Clark, 1918 is extended to northwestern Brazil. The class Ophiuroidea was dominant in samples in terms of abundance and frequency of occurrence, in particular Amphiodia atra Stimpson, 1852, Amphipholis subtilis (Ljungman, 1867), Ophiactislymani Ljungman, 1871and Ophiostigma isocanthum (Say, 1825). The asteroid Oreaster reticulatus (Linnaeus, 1758) is considered vulnerable to human exploration and was scarce during the surveys. Other species found at BTS, such the asteroids Luidia clathrata (Say, 1825) and L. senegalensis (Lamarck, 1816) and the echinoid Eucidaristribuloides (Lamarck, 1816)are included in the national list of threatened invertebrate species