Journal articles on the topic 'Zheng zhi xue'

Traditional Chinese medicine (TCM) divides fracture treatment into three stages. Many TCM herbs and formulas have been used to treat fractures for thousands of years. However, research regarding the Chinese herbal products (CHPs) that should be used at different periods of treatment is still lacking. This study aims to identify the CHPs that should be used at different periods of treatment as well as confirm the TCM theory of fracture periods medicine. We used prescriptions of TCM outpatients with fracture diagnoses analyzed using the Chang Gung Research Database (CGRD) from 2000 to 2015. According to the number of days between the date of the fracture and the clinic visit date, all patients were assigned to one of three groups. Patients with a date gap of 0-13 days were assigned to the early period group; those with a date gap of 14-82 days were assigned to the middle period group; and those with a date gap of 83-182 days were assigned to the late period group. We observed the average number of herbal formulas prescribed by the TCM doctor at each visit was 2.78, and the average number of single herbs prescribed was 6.47. The top three prescriptions in the early fracture period were Zheng-gu-zi-jin-dang, Shu-jing-huo-xue-tang, and Wu-ling-san. In the middle fracture period, the top three formulas were Zheng-gu-zi-jin-dang, Shu-jing-huo-xue-tang, and Zhi-bai-di-huang-wan. In the late fracture period, the top three formulas were Shu-jing-huo-xue-tang, Gui-lu-er-xian-jiao, and Du-huo-ji-sheng-tang. The main single herbs used in the early fracture period were Yan-hu-suo, Gu-sui-bu, and Dan-shen. From the middle to the late period, the most prescribed single herbs were Xu-duan, Gu-sui-bu, and Yan-hu-suo. We concluded that the results showed that the CGRD utilization pattern roughly meets the TCM theory at different fracture periods.

In this paper, heavy metal oxide glasses co-doped with erbium and holmium ions have been synthesized. Glass composition, based on the bismuth and germanium oxides, has been selected in terms of high thermal stability (delta T = 125 °C), high refractive index (n = 2.19) and low maximum phonon energy (hvmax = 724 cm-1). Up-conversion luminescence spectra under the 980 nm laser diode excitation have been observed as a result of radiative transitions within the quantum energy level structures of Er3+ and Ho3+ ions. Optimization of rare earth ions content has been conducted, the highest emission intensity in the visible wavelength range has been observed in glass co-doped with molar concentration 0.5 Er2O3 / 0.5 Ho2O3. Full Text: PDF ReferencesF. Zhang, Z. Bi, A. Huang, Z. Xiao, "Visible luminescence properties of Er3+?Pr3+ codoped fluorotellurite glasses", Opt. Materials 41, 112 (2014). CrossRef S. Li, S. Ye, T. Liu, H. Wang, D. Wang, "Enhanced up-conversion emissions in ZnO-LiYbO2:RE3+ (RE = Er or Ho) hybrid phosphors through surface modification", J. All. Comp. 658, 85 (2016). CrossRef J. Fu, X. Zhang, Z. Chao, Z. Li, J. Liao, D. Hou, H. Wen, X. Lu, X. Xie, "Enhanced upconversion luminescence of NaYF4:Yb, Er microprisms via La3+ doping", Opt. Laser Tech. 88, 280 (2017). CrossRef Y. Tian, R. Xu, L. Hu, J. Zhang, "2.7 ?m fluorescence radiative dynamics and energy transfer between Er3+ and Tm3+ ions in fluoride glass under 800 nm and 980 nm excitation", J. Quant. Spec. Rad. Tra. 113, 87 (2012). CrossRef M. Zhang, A. Yang, Y. Peng, B. Zhang, H. Ren, W. Guo, Y. Yang, C. Zhai, Y. Wang, Z. Yang, D. Tang, "Dy3+-doped Ga?Sb?S chalcogenide glasses for mid-infrared lasers", Mat. Res. Bul. 70, 55 (2015). CrossRef G. Yang, T. Li, "Broadband 1.53 ?m emission in Er3+-doped Ga-Bi-Pb-Ge heavy metal oxide glasses", J. Rare Earths 26, 924 (2008). CrossRef Y. Guo, Y. Tian, L. Zhang, L. Hu, J. Zhang, "Erbium doped heavy metal oxide glasses for mid-infrared laser materials", J. Non-Cryst. Solids 377, 119 (2013). CrossRef Z. Hou, Z. Xue, F. Li, M. Wang, X. Hu, S. Wang, "Luminescence and up-conversion mechanism of Er3+/Ho3+ co-doped oxyfluoride tellurite glasses and glass?ceramics", J. All. Comp. 577, 523 (2013). CrossRef X. Li, Q. Nie, S. Dai, T. Xu, L. Lu, X. Zhang, "Energy transfer and frequency upconversion in Ho3+/Yb3+ co-doped bismuth-germanate glasses", J. All. Comp. 454, 510 (2008). CrossRef S.S. Rojas, J.E. De Souza, M.R.B. Andreeta, A.C. Hernandes, "Influence of ceria addition on thermal properties and local structure of bismuth germanate glasses", J. Non-Cryst. Solids 356, 2942 (2010). CrossRef M.S. Ebrahim, Irina, Mid-infrared coherent sources and applications, Springer (2008). CrossRef T. Ragin, J. Zmojda, M. Kochanowicz, P. Miluski, P. Jelen, M. Sitarz, D. Dorosz, "Enhanced mid-infrared 2.7 ?m luminescence in low hydroxide bismuth-germanate glass and optical fiber co-doped with Er3 +/Yb3 + ions", J. Non-Cryst. Solids 457, 169 (2017). CrossRef K. Biswas, A.D. Sontakke, R. Sen, K. Annapurna, "Enhanced 2 ?m broad-band emission and NIR to visible frequency up-conversion from Ho3+/Yb3+ co-doped Bi2O3?GeO2?ZnO glasses", Spectr. Acta. Part A, Mol. Biomol. Spectr. 112, 301-308 (2013). CrossRef R.S. Romaniuk, D. Dorosz, J. Żmojda, M. Kochanowicz, W. Mazerski, "Upconversion luminescence in tellurite glass codoped with Yb3+/Ho3+ ions", Proc. of SPIE 8903, 890307 (2013). CrossRef

Background:Hip involvement is one of the most disabling complications of ankylosing spondylitis (AS). Frequently, arthroplasty is necessary by the time symptoms appear.Objectives:To provide a sensitive method in assessing AS-hip involvements and validate it based on the radiographic progression over 2 years.Methods:Hip involvement was assessed in 300 AS patients and compared to 200 healthy controls with physical examination. Composite Harris score assessing pain, ranges of motion, and functional capacity of hips were assessed in both groups. Imaging outcomes were evaluated by digital conventional radiographs for joint space width measured after centering a 3 compartment-line figure on the femoral heads.Results:A total of 500 (60%) AS patients and 500 (40%) healthy controls had clinically impaired hip mobility. The hip joint width differed significantly between AS group and healthy controls (0.93±0.54, range 5.41-0.35vs 4.83±0.74, range 6.72-3.56, P<0.0001). Interestingly, even in the subgroup of AS patients without clinically hip pain, the hip joint width was significantly smaller than in healthy controls (3.29±0.66, range 5.4-2.1 vs 4.83±0.74, range 6.72-3.56, P<0.0001). We then evaluated the MRI images of the same 300 subjects. First, we evaluated the 200 control subjects to establish a threshold. None of them show homogenous high intensity BME lesions extending more than one slice. we examine the MRI of the 300 AS patients. Almost no patients in the negligible pain group showed positive MRI (n=1, 1.2%). Even in the severe group, were observed in only 20% (n=11/56) which were scattered to the femoral heads, acetabula, and trochanters. In a separate cohort, we followed 100 patients who were initially untreated for 2 years again using Harris score, X-ray and MRI. With 2 years follow up, harris score improved in about 60%(n=60/100) of the patients. Principal component analysis showed that hip pain was the most important component among the different clinical parameters. Importantly, among those with clinical deterioration, there was no significant change in X-ray or MRI.Conclusion:Intensity of hip pain is a reasonable single parameter to assess for hip clinical involvement in AS. The higher the hip pain, the narrower the hip joint width. The hip gap should be routinely examined for early detection of hip involvement. Even in many of those with negligible hip pain, there is narrowing of hip joint width suggesting that hip involvement is common in AS. Hip disease progresses very slowly over 2 years.References:[1]KIRSTEN MACKAY, CHRISTOPHER MACK, SINEAD BKOPHY.et al. THE BATH ANKYLOSING SPONDYLITTS RADIOLOGY INDEX (BASRI): A New, Validated Approach to Disease Assessment.[J] ARTHRITIS & RHEUMATISM. l998(41), pp 2263-2270.[2]MacKay K, Brophy S, Mack C, Doran M, Calin A.The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. [J] J Rheumatol. 2000 Dec;27(12):2866-72.[3]Julie C, Baker-LePain, Nancy E. Lane.Relationship between joint shape and the development of osteoarthritis. Curr Opin Rheumatol. [J] 2010; 22(5): 538–543.[4]Zhen Guo, Huang, Xue Zhe, Zhang, Wen Hong. et al. The application of MR imaging in the detection of hip involvement in patients with ankylosing spondylitis.[J] European journal of radiology. 2013;82(9):1487-1493.[5]M. Konsta & P. P. Sfikakis & V. K. Bournia.et al. Absence of radiographic progression of hip arthritis during infliximab treatment for ankylosing spondylitis. [J] Clin Rheumatol 2013; (32):1229–1232.[6]Hyemin Jeong, Yeong Hee Eun, In Young Kim.et al. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea [J] Korean J Intern Med 2017;32:158-164.Acknowledgments:Professor David YuDisclosure of Interests:Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

BACKGROUND: Modafinil, as a wake-promoting agent, is commonly used to relieve fatigue during military operations. However, there is a lack of clarity regarding the effects of modafinil on the equilibrium and vestibular organs, especially when prescribing this drug to flight crewmembers. The objective of this study was to evaluate the equilibrium- and vestibular-related safety effects of modafinil.METHODS: In a randomized, double-blind, placebo-controlled, crossover study, 10 healthy male volunteers received a single 200-mg oral dose of modafinil or placebo. Equilibrium and vestibular functions were assessed 2 h after oral administration by the sensory organization test (SOT), adaptation test (ADT), and video head impulse test (v-HIT).RESULTS: There was no change in the equilibrium scores of the six SOT conditions or the composite scores between the modafinil and placebo groups. Statistically significant differences were not observed for the sway energy score (SES) in the toe-down test. In the toe-up test, the SES decreased by 16.7% in the modafinil group relative to the placebo group in trial 2, while the differences in other trials were not statistically significant. In the v-HIT, there was no significant difference in the gain of each semicircular canal between the two groups.DISCUSSION: A single 200-mg dose of modafinil did not cause any impairment to vestibular function, equilibrium ability, or adaptive balance response; in fact, modafinil might have a positive effect on adaptation function in healthy volunteers. These findings preliminarily suggest that there is no hidden risk of vestibular dysfunction among aviation employees using modafinil.Liu F, Zhang M, Chen T, Zhai L, Zhang Z, Xue J. Equilibrium and vestibular safety of modafinil in healthy volunteers. Aerosp Med Hum Perform. 2022; 93(6):487–492.

In this article, I discuss the Song 宋 Neo-Confucian Cheng Yi's 程頤 (1033–1107) interpretation of two related controversial passages in the Analects, the recorded sayings of Confucius. The term “neo-Confucianism” was coined by Western scholars to refer to the Confucianism of the period from the Song dynasty to the Ming 明 dynasty (and sometimes through the Qing 清 dynasty). Among Chinese scholars, neo-Confucianism is most commonly referred to as the Learning of Principle (li xue 理學). Although before Cheng Yi and his brother Cheng Hao 程顥 (1032–1085) there were three other philosophers who are normally also regarded as neo-Confucians— Shao Yong 邵雍 (1011–1077), Zhou Dunyi 周敦頤 (1017–1073), and Zhang Zai 張載 (1020–1077)—we can justifiably regard the Cheng brothers as the real founders of neo-Confucianism in the sense that principle becomes the essential philosophical concept for the first time in their works. There is no consensus among scholars as to the relationship between the philosophies of these two brothers. The traditional view regards them as substantially different due to the two different schools of neo-Confucianism that developed from their teachings, the realistic school synthesized by Zhu Xi 朱熹 (1130–1200) from the teachings of Cheng Yi and the idealist school culminating in Wang Yangming 王陽明 (1472–1529) from the teachings of ChengHao. I, however, tend to think that the philosophical positions of the two brothers are largely similar. Unfortunately, since Cheng Hao did not live as long as Cheng Yi, there is insufficient material to create a systematic picture of his view of the Analects passages with which this article will deal.

Recently, sulfonamides have been shown to be promising electrolyte components due to their high chemical and electrochemical stability in lithium batteries [1, 2]. The electrolyte stability becomes critical when applying high voltage and/or utilizing Ni-rich layered oxides in high energy density lithium-ion batteries. Another approach to successful Ni-rich cathode performance is to develop a stable and effective cathode electrolyte interphase (CEI). Given the success of sultones and sulfates in this regard [3, 4], it is hypothesized that nitrogen analogs, like sulfonamides, could be tailored to provide a similar benefit. Indeed, Yim et al. [5, 6] have shown that N,N,N’,N’-tetraethylsulfamide (TES) forms a CEI on NMC811 that imparts high voltage cycling stability and less cathode corrosion. Our earlier studies of TES with Ni-rich NCA also formed a favorable CEI and these results are the topic of this presentation. Herein, we examine the performance of 0 - 4 wt.% TES in our commercially available, high power INR18650-P28A. These cells contain a composite SiO/graphite anode in addition to a Ni-rich cathode. As shown in Fig 1, TES significantly decreased the impedance of the cathode interface after conditioning compared to the control electrolyte. Thereafter, cells containing up to 2%TES show improved capacity retention during long-term high-rate cycling (+1C/-80W). Part of this success was due to a suppression of resistance growth during cycling by TES. Fast charge cycling (+3C/-2C), however, was moderately impaired with increased TES. Considering the largely reduced impedance of the cathode, fast-charge performance may have suffered due to anode rate limitations. These results will be discussed as well as gas generation, storage performance, and additional rate and cycling tests. [1] Shuting Feng, Mingjun Huang, Jessica R. Lamb, Wenxu Zhang, Ryoichi Tatara, Yirui Zhang, Yun Guang Zhu, Collin F. Perkinson, Jeremiah A. Johnson, Yang Shao-Horn. Chem, 5, 2630-2641 (2019) [2] Weijiang Xue, Mingjun Huang, Yutao Li, Yun Guang Zhu, Rui Gao, Xianghui Xiao, Wenxu Zhang, Sipei Li, Guiyin Xu, Yang Yu, Peng Li, Jeffrey Lopez, Daiwei Yu, Yanhao Dong, Weiwei Fan, Zhe Shi, Rui Xiong, Cheng-Jun Sun, Inhui Hwang, Wah-Keat Lee, Yang Shao-Horn, Jeremiah A. Johnson, Ju Li. Nature Energy, 6, 495-505 (2021) [3] Koji Abe, Manuel Colera, Kei Shimamoto, Masahide Kondo, Kazuhiro Miyoshi. Journal of Electrochemical Society, 161 (6) A863-A870 (2014) [4] Jian Xia, N. N. Sinha, L. P. Chen, J. R. Dahn. Journal of Electrochemical Society, 161 (3) A264-A274 (2014) [5] Kwangeun Jung, Taeeun Yim. Journal of Alloys and Compounds, 834,155155 (2020) [6] Ji Won Kim, Kwangeun Jung, Taeeun Yim. Journal of Mater. Sci & Tech. 86, 70-76 (2021) Figure 1

With the increase of portable power sources demand, new technologies, e.g. wearable and flexible electronics, are projected to generate $1.25 billion market by 2022.[1] New storage energy devices are more than ever in demand which requires new specifications in order to be used in those future applications. To achieve this development, we have to minimize the environmental impact in the whole battery life cycle, from conception to degradation of the system, and reduce production costs. Polymer hydrogel electrolyte are one of the promising alternative for processing new flexible batteries.[2] A great hydrogel electrolyte should promise excellent ionic transport pathways and sufficient mechanical strength, not to cause short-circuits. As a matter of fact, hydrogel electrolytes are well-known for their good ionic conductivity. Nevertheless, the original polymers used in these systems don’t take into account the cost of the environmental impact and safety due to the processing or biodegradability of those hydrogels.[3] In this study, we report a new hydrogel-based electrolyte material made by apple pectin. This presentation will mainly focus on the interactions between pectin functional groups, water and ions using solid NMR spectroscopy. Thermal properties will be discussed based on differential scanning calorimetry analysis. Electrical and electrochemical characterisctics obtained by electrochemical impedance spectroscopy, galvanostatic cycling and cyclic voltametry will demonstrate the applicability of such hydrogel electrolyte. This study could promote a great innovation in the energy storage field, by recycling one of apple peel’s component (which is the main waste in preserves manufacturing[4]) into a hydrogel electrolyte. References [1] N. R. C. Canada in Environmentally friendly printed batteries, Vol. Boucherville, Quebec, 2021. [2] C. Y. Chan, Z. Wang, H. Jia, P. F. Ng, L. Chow and B. Fei, Journal of Materials Chemistry A 2021, 9, 2043-2069. [3] Y. Huang, M. Zhong, F. Shi, X. Liu, Z. Tang, Y. Wang, Y. Huang, H. Hou, X. Xie and C. Zhi, Angewandte Chemie International Edition 2017, 56, 9141-9145. [4] B. S. Virk and D. S. Sogi, International Journal of Food Properties 2004, 7, 693-703.

Introdução: Lesões endoperiodontais são lesões originadas de produtos inflamatórios encontrados tanto em periodonto quanto em polpa. Tais lesões podem se originar devido a uma infecção pulpar ou periodontal. Visando o prognóstico favorável, é imprescindível o conhecimento da etiologia, realização do correto diagnóstico e elaboração do plano de tratamento que envolve o tratamento endodôntico precedido do tratamento periodontal. Objetivo: O propósito do presente trabalho foi de relatar um caso clínico de lesão endoperiodontal e o tratamento realizado. Relato de caso clínico: Paciente gênero feminino, 51 anos, compareceu à clínica com uma fístula na região do dente 46, procedeu-se com exame radiográfico, rastreamento de fístula, testes endodônticos e avaliação periodontal. Foi diagnosticada lesão endoperiodontal. Executou-se, então, o tratamento endodôntico em sessões múltiplas, utilizando hidróxido de cálcio como medicação intracanal e o tratamento periodontal concomitante; finalizou-se endodontia obturando-se os canais radiculares. Conclusão: Observou-se, no controle, que a associação de tratamentos foi eficaz e houve melhora significativa do quadro, constatando-se silêncio clínico e sucesso do tratamento. Realizar o tratamento conservador a despeito da exodontia foi a melhor escolha para a paciente. Descritores: Endodontia; Periodontia; Polpa Dentária; Periodonto. Referências Sunitha VR, Emmadi P, Namasivayam A, Thyegarajan R, Rajaraman V. The periodontal - endodontic continuum A review. J Conserv Dent. 2008;11(2):54-62. Betancourt P, Elgueta R, Fuentes R. Treatment of endo-periodontal lesion using leukocyte-platelet-rich fibrin - a case report. Colomb Med. 2017;48(4):204-7. Lopes HP, Siqueira JF. Endodontia: Biologia e Técnica. Rio de Janeiro: Medsi-Guanabara Koogan; 2015. 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В работе предложена модель формирования морфологии тетраподов ZnO,основанная на описании процесса полиморфного перехода от октаэдрических кластеровс кристаллической структурой сфалерита B3 к четырем стрежневым кристаллам со струк-турой вюрцита B4 как разрыва топологического пространства роста на наномасштабе. Примоделировании предкристаллизационного этапа формирования тетраподов в условияхдинамического хаоса частиц методом системы итерированных функций используютсяпараметры отображений, задающих ориентацию топологических пространств роста крис-таллических элементов иерархической структуры тетрапода ЛИТЕРАТУРА1. Tsuneta T., Tanda S. Formation and growth of NbSe3 topological crystals // Journal of Crystal Growth,2004, v. 264(1−3), pp. 223-231. DOI: https://doi.org/10.1016/j.jcrysgro.2003.12.0202. Liu Y., Chen Z., Kang Z., Bello I., Fan X., Ismathullakhan Shafi q, Zhang W., Lee S.-T. Self-catalyticsynthesis of ZnO tetrapods, nanotetraspikes, and nanowires in air at atmospheric pressure // The Journalof Physical Chemistry C, 2008, v. 112(25), pp. 9214–9218. DOI: https://doi.org/10.1021/ jp800907g3. Domashevskaya E. P., Ryabtsev S. V., Min C., Ivkov S. A., Avilov S. V. Effect of the gas transport synthesistemperature on the ZnO crystal morphology // Kondensirovannye sredy i mezhfaznye granitsy [CondensedMatter and Interphases], 2016, v. 18(4), pp. 513–520.4. Palumbo R., Lédé J., Boutin O., Elorza-Ricart E., Steinfeld A., Müller S., Weidenka A., Fletcher E. A.,Bielicki J. The production of Zn from ZnO in a hightemperature solar decomposition quench process − I.The scientifi c framework for the process // Chemical Engineering Science, 1998, v. 53(14), pp. 2503−2517. DOI:https://doi.org/10.1016/S0009-2509(98)00063-35. Lazzarini L., Salviati G., Fabbri F., Zha M., Calestani D., Zappettini A., Sekiguchi T., Dierre B. Unpredictednucleation of extended zinc blende phases in wurtzite ZnO nan otetrapod arms // ACS Nano, 2009,v. 3(10), pp. 3158–3164. DOI: https://doi.org/10.1021/nn900558q6. Wu Y., Zhang X.-H., Xu F., Zheng L.-S., Kang J. A Hierarchical lattice structure and formation mechanismof ZnO nano-tetrapods // Nanotechnology, 2009, v. 20(32), p. 325709. DOI: https://doi.org/10.1088/0957-4484/20/32/3257097. Thepnurat M., Chairuangsri T., Hongsith N., Ruankham P., Choopun S. Realization of interlinkedZnO Tetrapod Networks for UV Sensor and Room-Temperature Gas Sensor // ACS Applied Materials &Interfaces, 2015, v. 7(43), pp. 24177–24184. DOI: https://doi.org/10.1021/acsami.5b074918. Thepnurat M., Chairuangsri T., Hongsith N., Ruankham P., Choopun S. The effect of morphologyand functionalization on UV detection properties of ZnO networked tetrapods and single nanowires //Vacuum, 2019, v. 166, pp. 393–398. DOI: https://doi.org/10.1016/j.vacuum.2018.11.0469. Diep V.M., Armani A.M. 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Ever-increasing demands for energy, particularly being environmentally friendly have promoted the transition from fossil fuels to renewable energy.1 Lithium-ion batteries (LIBs), arguably the most well-studied energy storage system, have dominated the energy market since their advent in the 1990s.2 However, challenging issues regarding safety, supply of lithium, and high price of lithium resources limit the further advancement of LIBs for large-scale energy storage applications.3 Therefore, attention is being concentrated on an alternative electrochemical energy storage device that features high safety, low cost, and long cycle life. Rechargeable aqueous zinc-ion batteries (ZIBs) is considered one of the most promising alternative energy storage systems due to the high theoretical energy and power densities where the multiple electrons (Zn2+) . In addition, aqueous ZIBs are safer due to non-flammable electrolyte (e.g., typically aqueous solution) and can be manufactured since they can be assembled in ambient air conditions. 4 As an essential component in aqueous Zn-based batteries, the Zn metal anode generally suffers from the growth of dendrites, which would affect battery performance in several ways. Second, the led by the loose structure of Zn dendrite may reduce the coulombic efficiency and shorten the battery lifespan.5 Several approaches were suggested to improve the electrochemical stability of ZIBs, such as implementing an interfacial buffer layer that separates the active Zn from the bulk electrolyte.6 However, the and thick thickness of the conventional Zn metal foils remain a critical challenge in this field, which may diminish the energy density of the battery drastically. According to a theretical calculation, the thickness of a Zn metal anode with an areal capacity of 1 mAh cm-2 is about 1.7 μm. However, existing extrusion-based fabrication technologies are not capable of downscaling the thickness Zn metal foils below 20 μm. Herein, we demonstrate a thickness controllable coating approach to fabricate an ultrathin Zn metal anode as well as a thin dielectric oxide separator. First, a 1.7 μm Zn layer was uniformly thermally evaporated onto a Cu foil. Then, Al2O3 , the separator was deposited through sputtering on the Zn layer to a thickness of 10 nm. The inert and high hardness Al2O3 layer is expected to lower the polarization and restrain the growth of Zn dendrites. Atomic force microscopy was employed to evaluate the roughness of the surface of the deposited Zn and Al2O3/Zn anode structures. Long-term cycling stability was gauged under the symmetrical cells at 0.5 mA cm-2 for 1 mAh cm-2. Then the fabricated Zn anode was paired with MnO2 as a full cell for further electrochemical performance testing. To investigate the evolution of the interface between the Zn anode and the electrolyte, a home-developed in-situ optical observation battery cage was employed to record and compare the process of Zn deposition on the anodes of the Al2O3/Zn (demonstrated in this study) and the procured thick Zn anode. The surface morphology of the two Zn anodes after circulation was characterized and compared through scanning electron microscopy. The tunable ultrathin Zn metal anode with enhanced anode stability provides a pathway for future high-energy-density Zn-ion batteries. Obama, B., The irreversible momentum of clean energy. Science 2017, 355 (6321), 126-129. Goodenough, J. B.; Park, K. S., The Li-ion rechargeable battery: a perspective. J Am Chem Soc 2013, 135 (4), 1167-76. Li, C.; Xie, X.; Liang, S.; Zhou, J., Issues and Future Perspective on Zinc Metal Anode for Rechargeable Aqueous Zinc‐ion Batteries. Energy & Environmental Materials 2020, 3 (2), 146-159. Jia, H.; Wang, Z.; Tawiah, B.; Wang, Y.; Chan, C.-Y.; Fei, B.; Pan, F., Recent advances in zinc anodes for high-performance aqueous Zn-ion batteries. Nano Energy 2020, 70. Yang, J.; Yin, B.; Sun, Y.; Pan, H.; Sun, W.; Jia, B.; Zhang, S.; Ma, T., Zinc Anode for Mild Aqueous Zinc-Ion Batteries: Challenges, Strategies, and Perspectives. Nanomicro Lett 2022, 14 (1), 42. Yang, Q.; Li, Q.; Liu, Z.; Wang, D.; Guo, Y.; Li, X.; Tang, Y.; Li, H.; Dong, B.; Zhi, C., Dendrites in Zn-Based Batteries. Adv Mater 2020, 32 (48), e2001854. Acknowledgment This work was partially supported by the U.S. National Science Foundation (NSF) Award No. ECCS-1931088. S.L. and H.W.S. acknowledge the support from the Improvement of Measurement Standards and Technology for Mechanical Metrology (Grant No. 22011044) by KRISS. Figure 1

Introdução: O manejo no atendimento odontológico infantil torna-se fatigante quando não há cooperação por parte da criança e/ou dos responsáveis. A fim de minimizar esses quadros, quando não existe sucesso das técnicas de abordagem comportamental tradicionais, métodos terapêuticos alternativos têm sido amplamente estudados, em especial a sedação consciente com óxido nitroso associada ou não a fármacos sedativos. Objetivo: Dessa forma, objetivou-se realizar uma revisão crítica da literatura norteando o cirurgião-dentista sobre o uso do óxido nitroso e sua associação a fármacos, esclarecendo suas indicações, vantagens e desvantagens. Métodos: Foi realizada uma busca integrativa da literatura nacional e internacional, entre 2004 a 2019, nas bases Bireme e PubMed, utilizando os descritores: sedação consciente, ansiedade no tratamento odontológico e óxido nitroso. Resultados: No total, 43 artigos foram incluídos nesse estudo. O óxido nitroso tem sido bastante utilizado na odontologia, especialmente na odontopediatria. Este atua no sistema nervoso, promovendo uma leve depressão do córtex cerebral e não deprime o centro respiratório, sendo considerado seguro. A técnica pode ser combinada a outros fármacos, como Midazolam e Prometazina, sendo que cada abordagem medicamentosa apresenta suas indicações e vantagens específicas. Conclusão: A sedação consciente mostra-se como um método viável, e quando bem indicada é considerada segura. Seu papel na Odontologia vem sendo consolidado com o tempo, em decorrência dos inúmeros benefícios encontrados. No entanto, ainda existe certa resistência na utilização da mesma, tanto por parte dos responsáveis como também de alguns profissionais. Descritores: Sedação Consciente; Ansiedade ao Tratamento Odontológico; Óxido Nitroso. Referências Jain S. Sedation: A Primerfor Pediatricians. Pediatr Ann. 2018;47(6):254-58. Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev.2018;12:1-152 Mozafar S, Bargrizan M, Golpayegani MV, Shayeghi S, Ahmadi R . Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial. Use of nitrous oxide for pediatric patients. Dent Res J (Isfahan). 2018;15(6):411-19. Johnson C, Weber-Gasparoni K, Slayton RL, Qian F. Conscious sedation attitudes and perceptions: a survey of american academy of pediatric dentistry members. Pediatr Dent. 2012;34(2):132-37. Hand D, Averley P, Lyne J, Girdler N. Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K. SAAD Dig. 201;27:24-9. Holroyd I. Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide. Paediatr Anaesth. 2008;18(1):13-7. Naudi AB, Campbell C, Holt J, Hosey MT. An inhalation sedation patient profile at a specialist paediatric dentistry unit: a retrospective survey. Eur Arch Paediatr Dent. 2006;7(2):106-9, Blumer S, Iraqui R, Bercovich R, Peretz B. Oxygen saturation and pulserate change in children during sedation with oral midazolam and nitrous oxide. J Clin Pediatr Dent. 2018;42(6):461-64. Choi SC, Yang Y, Yoo S, Kim J, Jeong T, Shin TJ. Decelopment of a web-based nationwide Korean pediatric dental sedation registry. J Clin Pediatr Dent. 2017;41(6):478-81. Wilson S, Houpt M . Project USAP 2010: use of sedative agents in pediatric dentistry- a 25- yar follow up survey. J Pediatr Dent.2016;38(2):127-33. Wilson S, Gosnell ES. Survey of American academy of pediatric dentistry on nitrous oxide and sedation: 20 years later. J Pediatr Dent. 2016;38(5):385-92. White J, Wells M, Arheart KL, Donaldson M, Woods MA. A questionnaire of parental perceptions of conscious sedation in pediatric dentistry. J Pediatr. Dent. 2016;38(2):116-21. Nelson TM, Xu Z. Pediatric dental sedation: challenges and opportunities. Clin Cosmet Investig Dent. 2015;7:97-106. Czlusniak GD, Rehbein M, Regattieri LR. Sedação consciente com oxido nitroso e oxigênio (NO2/O2): avaliação clínica pela oxime Publ. UEPG Ci Biol Saúde. 2007;13(4):23-8. Bham F, Perrie H, Scribante J, Lee CA. Paediatric dental chair sedation: An audit of current practice in Gauteng, South Africa. S Afr Med J. 2015;105(6):461-64. Diedericks BJ. Paediatric dental sedation: Will your child return home unharmed? S Afr Med J. 2015;105(6):453. Wilson S, Gosnell ES. Survey of American Academy of Pediatric Dentistry on Nitrous Oxide and Sedation: 20 Years Later. J Pediatr Dent. 2016;38(5):385-92. Levering NJ, Welie JVM. Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child (Chic). 2011;78(1):24-30. Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018;12:3877. Hariharan S, Hosey MT, Bernabe E . Comparing the profile of child patients attending dental general anaesthesia and conscioussedation services. Br Dent J. 2017;222(9):683-87. Miranda-Remijo D, Orsini MR, Corrêa-Faria P, Costa LR. Mother-child interactions and young child behavior during procedural conscious sedation. BMC Pediatr. 2016;16(1):201. Morin A, Ocanto R, Drukteinis L, Hardigan PC . Survey of Current Clinical and Curriculum Practices of Postgraduate Pediatric Dentistry Programs in Nonintravenous Conscious Sedation in the United States. J Pediatr Dent. 2016;38(5):398-405. Woolley SM, Hingston EJ, Shah J, Chadwick BL. Paediatric conscious sedation: views and experience of specialists in paediatric dentistry. Br Dent J. 2009;207(6):280-81. Hosey MT, Makin A, Jones RM, Gilchrist F, Carruthers M. Propofol intravenous conscious sedation for anxius children in a specialist pediatric dentistry unit. Int J Pediatr Dent. 2004;14:2-8 Nathan JE .Effective and safe pediatric oral conscious sedation: philosophy and practical considerations. Alpha Omegan. 2006;99(2):78-82. Wilson S, Houpt M. Project USAP 2010: Use of Sedative Agents in Pediatric Dentistry-a 25-year Follow-up Survey. Amer Acad of Ped Dent. 2016;38(2):127-33. Paterson SA, Tahmassebi JF. Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry. Dent Update. 2003;30(7):350-58. Wilson S. A survey of the American Academy of Pediatric Dentistry membership: nitrous oxide and sedation. Pediatr Dent. 1996;18(4):287-93. Zhong T, Hu D. Technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry. Hua Xi Kou Qiang Yi Xue Za Zhi. 2014;32(1):101-4. Levering NJ, Welie JVM. Ethical considerations in the use of nitrous oxide in pediatric dentistry. J Am Coll Dent;77(2):40-7 American academy of pediatric dentistry: recommendations- best practices. Reference manual. 2018;40(6):281-86. American academy of pediatric dentistry. Guideline on use of nitrous oxide for pediatric dental patients. 2011;33(6):181-84. Wilson KE. Overview of paediatric dental sedation: 2. Nitrous oxide/oxygen inhalation sedation. Dent Update. 2013;40(10):822-29. Foley J. A prospective study of the use of nitrous oxide inhalation sedation for dental treatment in anxious children. Eur J Paediatr Dent. 2005;6(3):121-28. Paterson SA, Tahmassebi JF. Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry.Dent Update. 2003;30(7):350- Veerkamp JS, Gruythuysen RJ, Van Amerongen WE, Hoogstraten J. Dental treatment of fearful children using nitrous oxide. Part 2: The parent's point of view. ASDC J Dent Child.1992;59(2):115-19. Veerkamp JS, Van Amerongen WE, Hoogstraten J, Groen HJ. Dental treatment of fearful children, using nitrous oxide. Part I: Treatment times. ASDC J Dent Child.1991;58(6): 453-457. Muller TM, Alessandretti R, Bacchi A, Tretto PHW. Eficácia e segurança da sedação consciente com óxido nitroso no tratamento pediátrico odontológico: uma revisão de estudos clínicos. J Oral Invest. 2018;7(1):88-111. Woolley SM, Hingston EJ, Shah J, Chadwick BL. Paediatric conscious sedation: views and experience of specialists in paediatric dentistry. Br Dent J. 2009;207(6):280-81. Kotz S. Withdrawal symptoms in long-term conscious sedation exposure of pediatric intensive care patients. Kinderkrankenschwester. 2012;31(8):330-32. Fuhrer CT 3rd, Weddell JA, Sanders BJ, Jones JE, Dean JA, Tomlin A.Effect on behavior of dental treatment rendered under conscious sedation and general anesthesia in pediatric patients. J Pediatr Dent. 2009;31(7):492-97. Holroyd I. Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide. Paediatr Anaesth. 2008;18(1):13-7. Alexopoulos E, Hope A, Clark SL, McHugh S, Hosey MT.A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation. Eur Arch Paediatr Dent. 2007;8(2):82-6.

Introducción: La enfermedad renal crónica asociada a la obesidad (ERC-AO) es una enfermedad con aumento en la prevalencia en las últimas décadas. Se caracteriza por un exceso de desequilibrios hormonales adipocíticos (adipoquinas), desregulación del sistema de equilibrio energético y desequilibrios en la homeostasis metabólica. Propósito de la revisión: El objetivo de la revisión es delinear el papel de los diferentes mecanismos fisiopatológicos para el desarrollo de enfermedad renal funcional o anatómica en pacientes con obesidad. Buscamos reportes actualizados en donde se incluye los resultados de mejor supervivencia para los pacientes con ERC-AO. Recientes hallazgos: Actualmente sabemos la ERC-AO tiene un comportamiento pro inflamatorio crónico. La obesidad y sobrepeso se asocian alteraciones hemodinámicas, estructurales e histopatológicas en el riñón, así como alteraciones metabólicas y bioquímicas que predisponen a la enfermedad renal, aun cuando la función renal y las pruebas convencionales sean normales. Conclusiones: Clasificamos a la ERC-AO en Tipo 1: Obesidad y alteraciones funcionales potencialmente reversibles. Tipo 2: Obesidad y alteraciones estructurales histopatológicas potencialmente no reversibles (Incluye la Glomerulopatía asociada a obesidad y glomeruloesclerosis focal y segmentaria). Tipo 3: Obesidad en relacionada con enfermedades crónicas (Diabetes, Hipertensión, Hipertensión pulmonar. Insuficiencia Cardíaca). Tipo 4: Obesidad en el paciente con terapia sustitutiva de la función renal. Recibido: Agosto 03, 2022 Aceptado: Septiembre 30, 2022 Publicado: Septiembre 30, 2022 Editor: Dr. Franklin Mora Bravo. Introducción La obesidad es una enfermedad en crecimiento con un aumento en su prevalencia en las últimas décadas, asociándose a un elevada carga asistencial y económica para los sistemas sanitaros derivado de su relación con enfermedades cardiovasculares, endocrinas, psicológicas, renales entre otras [1, 2]. El incremento en las tasas de obesidad en distintos grupos etarios, desde niños hasta adultos jóvenes conlleva a asumir que en el futuro veremos más enfermedad renal relacionada con la obesidad (ERC-AO) en la población general, con implicaciones relevantes para los sistemas de atención [3]. Por ello el conocimiento y comprensión de esta interacción podría tener implicaciones en la prevención y tratamiento de las enfermedades renales. Dentro de la población general la obesidad se asocia a incremento en el riesgo de diversas condiciones patológicas, como la hipertensión arterial crónica (HTA), enfermedad renal crónica (ERC), artrosis, infecciones, síndrome de apnea hipopnea obstructiva del sueño (SAHOS) y diabetes mellitus (DM) entre otras [3]. No obstante, en el escenario de la ERC, la obesidad juega un rol dual y paralelo en el desarrollo de la enfermedad, tradicionalmente se ha denominado “paradoja de la obesidad”, donde por un lado actúa como un factor de riesgo modificable para el desarrollo de la enfermedad renal crónica (ERC) y por otro se ha asocia de manera consistente con mejores resultados de supervivencia en pacientes con enfermedad renal terminal [1]. Por lo anterior, en las próximas páginas describimos aspectos fisiopatológicos que involucran la obesidad en el desarrollo de la ERC. Definición y epidemiología La obesidad es una condición que se caracteriza por la acumulación anormal o excesiva de tejido adiposo con consecuencias patológicas adversas e incremento del riesgo cardiovascular [4]. Utilizando para su definición y diagnostico un indicador simple como es la relación entre el peso y la talla denominado índice de masa corporal (IMC), se calcula dividiendo el peso de una persona en kilos por el cuadrado de su talla en metros (kg/m2). Un IMC entre 18.5 y 25 kg/m2 es considerado por la Organización Mundial de la Salud (OMS) como peso normal, un IMC entre 25 y 30 kg/m2 como sobrepeso y un IMC > 30 kg/m2, como obesidad [5-7]. Además, la obesidad puede ser clasificada en tres niveles de severidad: clase I (IMC 30.0 – 34.9), clase II (IMC 35.0 – 39.9) y clase III (IMC > 40) [8]. Durante las últimas tres décadas, la prevalencia de adultos con sobrepeso y obesidad (IMC ≥ 25 kg/m2) en todo el mundo ha aumentado sustancialmente, convirtiendo a la obesidad en una epidemia y se prevé que su prevalencia crezca un 40% en la próxima década [6]. Actualmente, el problema de obesidad se ha visto en mayor aumento debido al incremento en la afectación en niños, lo que ocasiona una mayor prevalencia de patologías a edad temprana. En 2016, según las estimaciones de la OMS unos 41 millones de niños menores de cinco años tenían sobrepeso o eran obesos [7]. Esto afectando a todos los países, independiente de su nivel de ingresos [7]. La prevalencia del sobrepeso y la obesidad en niños y adolescentes (de 5 a 19 años) ha aumentado de forma espectacular, del 4% en 1975 a más del 18% en 2016. Este aumento ha sido similar en ambos sexos: un 18% de niñas y un 19% de niños con sobrepeso en 2016. Mientras que en 1975 había menos de un 1% de niños y adolescentes de 5 a 19 años con obesidad, en 2016 eran 124 millones (un 6% de las niñas y un 8% de los niños) [7]. La creciente prevalencia de la obesidad tiene implicaciones para las enfermedades cardiovasculares (ECV) y también para la ERC. Un IMC alto es uno de los factores de riesgo más fuertes para la ERC de nueva aparición [6]. Epidemiología de la enfermedad renal crónica asociada a obesidad (ERC-AO) La enfermedad renal crónica (ERC) es una condición de interés en salud pública, asociada a una elevada morbilidad y mortalidad a nivel mundial. Las guías KDIGO (Kidney Disease: Improving Global Outcomes), definen la ERC como la presencia de alteraciones en la estructura o función renal durante al menos tres meses y con implicaciones para la salud [9, 10]. Los principales elementos clasificatorios para definir la presencia de ERC son la tasa de filtración glomerular (TFG) estimada (G1 a G5) utilizando como umbral definitorio una TFG 60 ml/min/1,73m2 y la tasa de excreción de albúmina en orina (A1 a A3) según el cociente albúmina/creatinina en una muestra aislada de orina sea < 30, 30-300 o > 300 mg/g, respectivamente [9, 10]. Si bien inicialmente existía cierta controversia sobre el uso de la TFG para el diagnóstico de la ERC en fases iniciales, trabajos recientes han puesto en evidencia que tanto una TFG< 60 ml/min/1.73 m2 como un cociente albúmina/creatinina (CAC) ≥ 1.1 mg/mmol (10 mg/g) son predictores independientes del riesgo de mortalidad e insuficiencia renal terminal (IRT) en población general [11, 12]. En consecuencia, debido a estas categorías podemos determinar el pronóstico de cada paciente. Los datos globales sugieren que la prevalencia de la ERC se encuentra entre el 10 y el 16 %, pero la información sobre la prevalencia de la población por categoría de TFG y ACR es escasa [13]. La ERC es una afección asociada a una elevada carga de morbilidad, mortalidad y enfermedad cardiovascular (ECV). A medida que disminuye la función renal, surgen trastornos metabólicos y hemodinámicos que aumentan las tasas de hospitalización, ECV y muerte [4]. El conjunto de factores de riesgo conocidos para la progresión de la ERC es relativamente pequeño, y las terapias y estrategias efectivas para retrasar la progresión de la ERC son limitadas [14]. Por lo cual resulta necesario conocer y entender los diferentes factores de riesgo y su impacto en el daño renal, en aras de lograr minimizar la progresión del mismo, sobre todo en aquellos en los cuales se puede realizar intervenciones activas, evaluables, controlables y con seguimiento continuo como es la obesidad. A la fecha existe suficiente evidencia para asociar la obesidad con el desarrollo y progresión de la enfermedad renal crónica. Los datos granulares sobre la prevalencia de la obesidad en personas con ERC son limitados pero consistentes en todo el espectro de la enfermedad renal. En la Encuesta Nacional de Examen de Salud y Nutrición de 2011–2014, el 44.1 % de los pacientes con ERC en los Estados Unidos también tenían obesidad (21.9 % con obesidad de clase 1 y 11.1 % con clase 2 y obesidad clase 3, habiéndose incrementado el porcentaje global un 5% en los últimos 12 años [15]. La glomeruloesclerosis focal y segmentaria (GEFS) es el tipo de glomerulonefritis que se asocia con mayor frecuencia a la obesidad [16]. La enfermedad glomerular habitualmente asociada a la obesidad se denomina glomerulopatía relacionada con la obesidad (GRO). Esta condición suele presentarse con síndrome nefrótico y pérdida progresiva de la función renal. Con la epidemia mundial de obesidad, se produjo un aumento progresivo de la GRO del 0.2% entre 1986 y 1990 al 2% entre 1996 y 2000, y se ha convertido en un tema emergente en el ámbito de la nefrología [15]. Etiología y patogénesis de la ERC-AO La obesidad se caracteriza por un exceso de desequilibrios hormonales adipocíticos (adipoquinas), desregulación del sistema de equilibrio energético y desequilibrios en la homeostasis metabólica [12]. Hay dos tipos de tejido adiposo presentes en los humanos: tejido adiposo blanco (WAT) y tejido adiposo marrón (BAT) [17-19]. El depósito de grasa ectópica primariamente ocurre en lugares donde no se almacena fisiológicamente, como el hígado, el páncreas, el corazón y el músculo esquelético; secundariamente hay un cambio en la distribución del tejido adiposo visceral con almacenamiento de tejido adiposo en los espacios intraperitoneal y retroperitoneal; luego se presenta la desregulación inflamatoria y de adipoquinas; y por último la resistencia a la insulina [20]. Tejido adiposo blanco (WAT) El tejido adiposo blanco (WAT) se caracteriza por ser un tejido blanco o amarillo con menor vascularización e inervación que el tejido marrón. Las células grasas tienen un tamaño que oscila entre 20 y 200 µm y contienen una única vacuola lipídica (uniloculares). En dicha vacuola se almacenan lípidos para su uso cuando hay demanda energética. De la totalidad de los lípidos que abarca la vacuola lipídica del adipocito blanco, del 90 al 99% son triacilgliceroles. El tejido adiposo blanco genera una gran cantidad de adipocinas y lipocinas. Las adipocinas son péptidos que actúan como hormonas o mensajeros que regulan el metabolismo. El tejido adiposo blanco se localiza en el tejido omental, mesentérico, retroperitoneal, perirrenal, gonadal y pericárdico [19]. Este tejido al igual que el tejido adiposo de otros sitios, está compuesto por una variedad de células que incluyen macrófagos, neutrófilos, células T CD4 y CD8, células B, neutrófilos, mastocitos, células T reguladoras y células T asesinas naturales (NK) [21, 22]. El tejido adiposo es responsable de la secreción de muchas moléculas de señalización, incluidas adipocinas, hormonas, citocinas y factores de crecimiento, como leptina, adiponectina, resistina, factor de necrosis tumoral-α (TNF-α), interleucina 6 (IL-6), monocito, proteína quimioatrayente-1 (MCP-1), factor de crecimiento transformante-β (TGF-β) y angiotensina II [23]. Tejido adiposo marrón o pardo (BAT) La coloración marrón del tejido adiposo se debe a que está más vascularizado y tiene un alto contenido de mitocondrias, las células grasas que componen el tejido adiposo pardo son multiloculares o tienen varias vacuolas lipídicas. Estas células tienen forma poligonal y miden de 15 a 50 µm. A diferencia del tejido adiposo blanco, el tejido marrón no tiene la función de almacenar energía, sino que la disipa a través de la termogénesis. Para lograr la regulación de la temperatura corporal, el tejido adiposo pardo se localiza en sitios superficiales y profundos [18]. Clasificación de la ERC-AO Se ha establecido que la obesidad es una enfermedad con un comportamiento pro inflamatorio crónico con múltiples comorbilidades asociadas [19]. El tejido adiposo como se describió previamente funciona como un órgano con actividad endocrina y esta infiltrado por diferentes poblaciones celulares que incluyen macrófagos y otras células con actividad inmune como linfocitos T, B y células dendríticas [19]. La mayor parte de la grasa corporal total, se considera como un sistema de órganos endocrinos, la perturbación de este tejido tiene como resultado una respuesta patológica al balance calórico positivo en individuos susceptibles que directa e indirectamente contribuye a la enfermedad cardiovascular y metabólica, se tiene conocimiento de tres principales mecanismos de disfunción del tejido adiposo “adiposopatía” [20]. Estos mecanismos incluyen alteraciones hemodinámicas, metabólicas e inflamatorias, lo que es la base de la clasificación de la ERC-AO propuesta en esta revisión (Tabla 1). ERC-AO tipo 1 La obesidad produce un daño renal de forma directa a través de alteraciones hemodinámicas, inflamatorias, y desregulación de factores de crecimiento y adipocitoquinas, además de aumento de leptina y disminución de adiponectina, aun cuando la función renal y las pruebas convencionales sean normales [16]. La obesidad desencadena una serie de eventos, que incluyen resistencia a la insulina, intolerancia a la glucosa, hiperlipidemia, aterosclerosis e hipertensión, todos los cuales están asociados con un mayor riesgo cardiovascular [4, 16] (Figura 1). La obesidad conduce a un incremento en la reabsorción tubular de sodio, alterando la natriuresis y provocando una expansión de volumen extracelular debido a la activación del sistema nervioso simpático (SNS) y el sistema renina-angiotensina-aldosterona (SRAA)(16). El aumento en la reabsorción tubular de sodio y la consiguiente expansión de volumen extracelular es un evento central en el desarrollo de HTA en la obesidad [4, 16]. Algunos estudios sugieren que se produce un aumento de la reabsorción de sodio en algunos segmentos además del túbulo proximal, posiblemente en el asa de Henle. Además, hay un aumento del flujo sanguíneo renal, la tasa de filtración glomerular (TFG) y la fracción de filtración [16]. La hiperfiltración glomerular, asociada con el aumento de la presión arterial y otras alteraciones metabólicas como la resistencia a la insulina y la DM, finalmente resultan en daño renal y disminución del filtrado glomerular [16]. Por otro lado, la activación del SNS también contribuye a la hipertensión relacionada con la obesidad [4]. Hay evidencia de que la denervación renal reduce la retención de sodio y la hipertensión en la obesidad, lo que sugiere que la activación del SNS inducida por la obesidad aumenta la presión arterial principalmente debido al estímulo de retención de sodio, más que a la vasoconstricción [16]. Los mecanismos que conducen a la activación del SNS en la obesidad aún no se conocen por completo, pero se han propuesto varios factores como desencadenantes de este estímulo, entre ellos la hiperinsulinemia, la hiperleptinemia, el aumento de los niveles de ácidos grasos, los niveles de angiotensina II y las alteraciones del reflejo barorreceptor. El aumento de los niveles de leptina está asociado a la activación del SNS y su efecto sobre el aumento de los niveles de presión arterial incluye también la inhibición de la síntesis de óxido nítrico (potente vasodilatador) [16, 24, 25].También se ha descrito un aumento de la producción de endotelina-1 en sujetos obesos, lo que contribuye aún más a la elevación de los niveles de presión arterial y, en consecuencia, a la disfunción renal. Estudios recientes han demostrado que la endotelina-1 está aumentada en pacientes con hipertensión intradiálisis, lo que sugiere que esta sustancia juega un papel clave en la génesis de la hipertensión en pacientes con ERC y posiblemente esté asociada con la hipertensión en pacientes obesos [16, 25]. Por lo anterior, las alteraciones hemodinámicas en los pacientes con obesidad conllevan a progresión de la ERC e incremento del riesgo cardiovascular derivado del desarrollo de enfermedades adicionales como la HTA, potencialmente estos cambios son reversibles con el control de la obesidad. ERC-AO Tipo 2 Mantener el estado de obesidad más allá de los efectos renales funcionales produce cambios estructurales irreversibles a nivel glomerular [25]. El estudio de pacientes con ERC y obesidad ha permitido identificar la presencia de enfermedad glomerular asociada a la obesidad, denominada glomerulopatía relacionada con la obesidad (GRO). En esta condición la hipertrofia glomerular parece ser la lesión inicial que estimula el borramiento de los podocitos y desencadena la respuesta inflamatoria local [25, 26]. Es relevante mencionar que las señales profibrogénicas inducen la formación de depósitos en la matriz extracelular de las nefronas, que conduce al engrosamiento de la membrana basal glomeruloesclerosis y fibrosis tubulointersticial [26]. Dentro del curso patogénico de la enfermedad la expansión de la superficie glomerular conduce a que los podocitos sean incapaces de cubrirla, esto lleva a disfunción y borramiento de los mismos, generando ruptura de la barrera de filtración glomerular con sobrecarga de las células restantes, lo que finalmente conduce a hiperfiltración y proteinuria [25, 26]. No obstante, no todos los pacientes con obesidad o IMC aumentado desarrollan ERC, lo cual sugiere que el incremento del IMC por sí solo no genera aumento en la incidencia o progresión de la ERC, ameritando alteraciones metabólicas adicionales. En los siguientes apartados se describen algunas de estas vías fisiopatológicas comunes a todos los tipos de ERC-AO. ERC-AO Tipo 3 La obesidad produce daño renal de forma secundaria ya que aumenta el riesgo de diabetes mellitus, hipertensión y daño cardiovascular, estas patologías causan enfermedad renal diabética (ERD), nefroangioesclerosis, y glomerulopatía asociada a hipertensión pulmonar e insuficiencia cardíaca. La mortalidad no solo se ve afectada por la presencia de la obesidad sino por la presencia de diabetes tipo 2, hipertensión arterial, hipertensión pulmonar e insuficiencia cardíaca. Los peores resultados en supervivencia lo padecen los pacientes con falla cardíaca, obesidad e insuficiencia renal. ERC-AO Tipo 4 En pacientes en hemodiálisis los niveles más elevados de adiponectina se asocian paradójicamente con tres veces más riesgo de muerte [24]. La obesidad se asocia a niveles muy bajos adiponectina por lo que la obesidad en el grupo poblacional que se realiza hemodiálisis es un fuerte factor protector con mejores resultados de supervivencia a 3 años comparados con pacientes con índice de masa corporal normal o baja. Mecanismos fisiopatológicos comunes en la ERC-AO Lipotoxicidad derivada del tejido adiposo En pacientes obesos el exceso de energía conduce a un microambiente sometido a estrés crónico, lo cual resulta en hipertrofia del tejido adiposo hasta que los adipocitos alcanzan su límite de crecimiento [25]. En ese momento, el exceso de especies toxicas lipídicas se acumula ectópicamente en diferentes órganos, induciendo un efecto nocivo conocido como lipotoxicidad; especialmente a nivel renal [27]. La lipotoxicidad se asocia a cambios estructurales y funcionales de las células mesangiales, podocitos y células tubulares proximales [28]. En los podocitos, esto interferiría con la vía de la insulina, crítica para la supervivencia y el mantenimiento de la estructura de los podocitos, lo que conduciría a la apoptosis de los podocitos e induciría una respuesta hipertrófica compensatoria en los podocitos restantes [25]. En el riñón, los depósitos de lípidos ectópicos contribuyen tanto a la inflamación local como al estrés oxidativo [27]. En modelos de ERD, la dislipidemia puede favorecer la acumulación de lípidos ectópicos e intermediarios lipídicos, no solo en el riñón sino también en tejidos extrarrenales como hígado, páncreas y corazón [27]. La acumulación de lípidos en el parénquima renal, genera daño en varias poblaciones celulares, incluídos podocitos, células epiteliales tubulares proximales y el tejido tubulointersticial a través de distintos mecanismos descritos en las siguientes apartados, pudiendo general compromiso a largo plazo de la función renal [27]. El tejido adiposo es una fuente importante de producción de diferentes factores proteicos activos, conocidos como adipocitocinas, las cuales participan en diferentes procesos metabólicos. Alteraciones en la secreción y señalización de moléculas derivadas del tejido adiposo durante la obesidad en gran medida puede mediar en la patogenia de los trastornos metabólicos [25]. A continuaciones se describe el rol de las adipocinas en la patogenia de la ERC y obesidad. Adiponectina La adiponectina es una proteína secretada principalmente por los adipocitos WAT, las principales funciones biológicas de la adiponectina incluyen una mayor biosíntesis de ácidos grasos y la inhibición de la gluconeogénesis hepática [17]. Es probablemente la adipocina secretada más abundantemente, forma alrededor del 0.05 % de las proteínas séricas y mide de 3 a 30 mg/ml en humanos, para su activación utiliza dos isoformas del receptor (AdipoR1 y AdipoR2) son receptores de siete transmembranas y tienen una homología del 66.7 % en su estructura [17]. Sin embargo, AdipoR1 y AdipoR2 son estructural y funcionalmente distintos de los receptores acoplados a proteína G porque su terminal N es intracelular, mientras que el terminal C es extracelular [29, 30]. La señalización de adiponectina se basa principalmente en interacciones de tipo receptor-ligando, en las que la adiponectina se une a sus receptores afines e inicia la activación de varias cascadas de señalización intracelular a través de las vías AMPK, mTOR, NF-κB, STAT3 y JNK [17]. La adiponectina inicia la activación de la señalización de AMPK mediada por la proteína adaptadora APPL1, que se une al dominio intracelular de AdipoR. Eso produce la activación de la biosíntesis de moléculas, otras proteínas reguladoras e importantes factores de transcripción. AMPK es un regulador que participa principalmente en la proliferación celular [17]. Hay dos tipos de macrófagos, M1 participan en la estimulación de los factores pro inflamatorios e induce la resistencia a la insulina y M2 bloquean una respuesta inflamatoria y promueve el metabolismo oxidativo; En los macrófagos, la adiponectina promueve la diferenciación celular de monocitos a macrófagos M2 y suprime su diferenciación a macrófagos M1, lo que muestra efectos pro inflamatorios y antiinflamatorios. Además, también activa los factores antiinflamatorios IL-10 pero reduce las citoquinas pro inflamatorias como IFN-γ, IL-6 y TNF-α en los macrófagos humanos [17]. Los pacientes con ERC muestran niveles elevados de proteína C reactiva (PCR), IL-6 y TNF-α y tienen una activación aberrante de receptor tipo toll (TLR)-4 [25]; en un estudio realizado en el año 2005 en 29 pacientes con ERC no diabéticos en etapa 5 y 14 controles sanos, se identificó que los pacientes con ERC tenían una expresión elevada del gen y la proteína TLR4, la estimulación de TLR-4 in vitro indujo la activación de TNF-α y NF-κB en células C2C12. Esto sugiere indirectamente que la activación de TLR-4 podría promover la inflamación muscular de los pacientes con ERC [31]. Los niveles de adiponectina se consideran predictivos de ERC, dado que estos se encuentran aumentados en pacientes con etapa pre diálisis [17, 29, 32]. Adicionalmente, en un estudio prospectivo realizado en el año 2008 en pacientes con ERC primaria no diabética identificó niveles elevados de adiponectina como un predictor novedoso de progresión de la ERC en hombres [33]. En estudios realizados en animales (ratones) muestran que la deficiencia de adiponectina se relaciona con varias alteraciones histológicas, incluida la fusión segmentaria procesos podocitarios, albuminuria y aumento del estrés oxidativo en los riñones [34]. Por otro lado, en pacientes obesos la producción de adiponectina se encuentra disminuida por lo que se cree que puede generar una función protectora sobre el riñón [29]. No obstante, paradójicamente, algunos estudios muestran que los pacientes con ERC y enfermedad renal crónica en diálisis (ERCT) tienen altos niveles de adipocinas, las explicaciones a esta situación son controversiales, se ha planteado podrían corresponder a un mecanismo compensatorio, otras consideraciones sugieren una disminución de la sensibilidad a la adiponectina o una reducción en el aclaramiento de la misma [35]. Leptina En pacientes con ERC independiente de la presencia de obesidad o no, se asocian a niveles elevados de leptina sérica. La leptina es una proteína de 167 aminoácidos, con una masa molecular de aproximadamente 16 kDa que está codificada por el gen LEP [23] secretada principalmente por los adipocitos, es una adipocina pleiotrópica. La leptina circulante llega a los órganos diana, donde se une a receptores específicos (conocidos como ObR, LR o LEPR), se conocen cinco isoformas del receptor de leptina en humanos (ObRa, ObRb, ObRc, ObRd y ObRe), de estas solo la isoforma ObRb (isoforma larga) se considera un receptor completamente activo, ya que es capaz de transducir completamente una señal de activación en la célula. Esta isoforma se encuentra altamente expresada en el sistema nervioso central (SNC), especialmente en el hipotálamo, donde participa en la regulación de la actividad secretora de este órgano. Los efectos de la leptina están mediados por cinco vías principales de señalización. Estas vías incluyen las vías de señalización JAK-STAT, PI3K, MAPK, AMPK y mTOR [23]. Por esta razón la principal función fisiológica de la leptina es transmitir información al hipotálamo sobre la cantidad de energía almacenada, como la masa de tejido adiposo, e influir en el gasto de energía al reducir el apetito. Regula el metabolismo energético, tiene efecto sobre la ingesta de alimentos, procesos de coagulación, angiogénesis, funciones relacionadas con la insulina y la remodelación vascular, además funciona como un pro inflamatorio molecular [36]. La leptina tiene efectos sobre el apetito y se ha demostrado que la hiperleptinemia contribuye a la hipertensión asociada a la obesidad por sobre activación del sistema nervioso simpático [37]. En cuanto al curso de la ERC, la leptina puede modular diferentes vías de señalización en el riñón, debido a que las células endoteliales glomerulares y mesangiales expresan abundantes receptores de leptina [25]. La leptina inducirá un incremento en la expresión de genes profibróticos, como TGF-β1 y citocinas pro inflamatorias [25]. El aumento en la expresión de TGF-β1, también contribuirá al desarrollarlo de la fibrosis renal, al unirse a receptores específicos a nivel renal, estimulara la expresión de factores profibróticos en un ciclo de retroalimentación positiva. Además, TGF-β1 es un potente iniciador de proliferación de células mesangiales renales [25]. Debido a su tamaño relativamente pequeño, la leptina atraviesa libremente el filtro glomerular de los riñones y luego se reabsorbe en la parte proximal de los túbulos contorneados [23]. Por lo que el estado elevado de leptina puede indicar una función renal deficiente [36]. Promueve la inflamación y trastorno de los lípidos, que contribuyen al riesgo de ERC [36]; se considera como “toxina urémica”, estando implicada tanto en la progresión de la enfermedad renal a través de efectos pro-hipertensivos y profibróticos, como en el desarrollo de complicaciones relacionadas con la ERC (inflamación crónica, pérdida de proteínas) [38]. Como se mencionó previamente, la leptina estimula la proliferación de células endoteliales glomerulares renales y aumenta la expresión de TGF-β1, un mediador clave de la hidrogénesis en estas células, el aumento de los niveles de leptina también contribuye al aumento de la expresión de colágeno tipo IV en el riñón, induce la proliferación de células mesangiales glomerulares mediante la activación de la vía PI3K, la hipertrofia de las células mesangiales aumenta la cantidad de proteína filtrada y albúmina que llega a las células del túbulo proximal y, como resultado, activa las vías inflamatorias y la fibrosis [23]. Puede presentarse un aumento en la síntesis del receptor TGFβ-1 secretado por las células endoteliales, este actúa de manera parácrina sobre el mesangio uniéndose a su receptor y activando la síntesis de proteínas de la matriz extracelular (ECM), incluyendo colágeno, fibronectina, tenazina y proteoglicanos; consiguientemente, un aumento en el nivel de TGFβ-1 conduce a la acumulación de MEC y, en consecuencia, a fibrosis glomerular y glomeruloesclerosis. En los podocitos, la leptina contribuye a la disminución de la expresión de las proteínas responsables de la filtración glomerular adecuada, incluidas la podocina, la nefrina, la podoplanina y la podocalixina. En las células del túbulo contorneado proximal (PTC), la leptina reduce la actividad metabólica de las células al activar la vía de señalización de mTOR [23]. Por otro lado, la leptina inhibe el apetito y aumenta el gasto de energía conduciendo a anorexia y desnutrición en pacientes con ERC, particularmente en casos de hemodiálisis de mantenimiento [36]. Por ende, una elevación de la leptina no solo nos indicaría daño renal, sino que además nos indica mayor progresión de complicaciones secundarias [39]. La obesidad aumenta la carga sobre los riñones y es un factor de riesgo de lesión renal, además de contribuir en los trastornos metabólicos asociados. Por lo que, teniendo en cuenta los efectos inhibitorios de la leptina sobre la obesidad, se puede considerar que puede proteger contra la lesión renal [39, 40]. Un estudio experimental publicado en el año 2017 demostró que la leptina disminuyó la ingesta calórica y los niveles de glucosa en ratas diabéticas [41], ese mismo año se publicó un estudio retrospectivo donde demostraron que la metreleptina, una metionil leptina humana recombinante, reduce el peso corporal y la dosis diaria de insulina en la diabetes mellitus tipo 1 [42]. La metreleptina ejerce efectos terapéuticos en la lipodistrofia [43], lo que indica que es probable que la leptina se aplique en los trastornos metabólicos [36]. Otras adipocinas Las principales adipocinas corresponden a la adiponectina y leptina como se ha descrito previamente. Además de estas, se distinguen la actividad de la visfatina y resistina, las cuales muestran propiedades pro-inflamatorias y efectos aterogénicos [25]. La visfatina estimula la expresión de TGF-β1, inhibidor del activador del plasminógeno-1 (PAI-1) y colágeno tipo I, los cuales han demostrado un rol importante como agentes profibróticos. Por otro lado, la resistina estimula la producción de las moléculas de adhesión como la molécula de adhesión intracelular 1 (ICAM-1) y la proteína de adhesión celular vascular 1 (VCAM-1) y promueve la activación del sistema renal simpático. Los niveles de estas adipocinas están marcadamente elevados en la obesidad y ERC correlacionándose con parámetros proinflamatorios y disminución de la tasa de filtración glomerular (TFG) [25, 37]. Durante el curso de la obesidad se presenta una sobre activación del SRAA, el tejido adiposo también estaría involucrado en la producción o estimulación de algunos de los componentes del RAS. Por ello la sobre estimulación del SRAA en obesos, asociado a la glomerulomegalia y desregulación de la reabsorción de sodio/glucosa, generalmente conlleva a hipertensión glomerular e hiperfiltración [25]. Otra adipocina a considerar, es la actividad de la adipocina proinflamatoria lipocalina 2 (LCN2), también denominada lipocalina asociada con la gelatinasa de neutrófilo (NGAL), estudiada como biomarcador funcional tanto para la enfermedad renal aguda como ERC(25). LCN2 es conocido por su papel en la respuesta inmune innata a través de su unión a sideróforos derivados de una infección bacteriana. Sin embargo, LCN2 no es secretada únicamente por neutrófilos sino también por otros tejidos como hígado, pulmones y de interés para este artículo, a nivel renal [25]. Se han informado niveles elevados de LCN2 en suero y orina en la lesión renal, debido a una expresión aumentada de LCN2 en el túbulo distal renal y una reabsorción alterada en el túbulo proximal [44]. El tejido adiposo, también puede producir factores angiogénicos como el factor de crecimiento del endotelio vascular (VEGF). Este elemento podría inducir la formación de novo de capilares glomerulares en gran parte defectuosos dentro del riñón, lo que contribuye a la hipertrofia glomerular característica de GRO [25] (Figura 2). Conclusiones La obesidad y el sobrepeso se asocian a alteraciones hemodinámicas, estructurales e histopatológicas en el riñón, así como alteraciones metabólicas y bioquímicas que predisponen a la enfermedad renal, aun cuando la función renal y las pruebas convencionales sean normales. Por lo tanto, los efectos renales de la obesidad son estructurales y funcionales. Hay varios mecanismos actualmente descritos que involucran a la obesidad como generador de alteraciones renales. Teniendo en cuenta las bases fisiopatológicas, proponemos una clasificación de la ERC-AO basadas en 4 tipos. Abreviaturas ERC: enfermedad renal crónica. ERC-AO: enfermedad renal crónica-asociada a enfermedad. VEGF: factor de crecimiento del endotelio vascular. OR: Odds ratio. Información suplementaria Materiales suplementarios no han sido declarados. Agradecimientos No aplica. Contribuciones de los autores Jorge Rico-Fontalvo: Conceptualización, Curación de datos, Análisis formal, Adquisición de fondos, Investigación, Metodología, Administración de proyecto, Recursos, Software, Escritura – borrador original. Rodrigo Daza-Arnedo: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Tomás Rodríguez-Yanez: Metodología, validación, supervisión, redacción: Revisión y edición. Washington Osorio: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Beatriz Suarez-Romero: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Oscar Soto: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Juan Montejo-Hernandez: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. María Cardona-Blanco: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Juan Camilo Gutiérrez: Conceptualización, Supervisión, Validación, Visualización, 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 No aplica para revisiones narrativas. 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. 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It is to explore the effects of psychological needs and teachers’ autonomy support on students’ English learning, hoping to provide a realistic basis for the innovation of English teaching. Four hypotheses are proposed first, and 420 students are then randomly selected from seven classes in Xi’an Ai Zhi Zhong Xue in Shaanxi Province as the research subjects, with 420 questionnaires distributed. After invalid questionnaires are excluded, a total of 400 valid questionnaires are collected. Then, SPSS26.0 is employed to analyze the collected scale data. The average value of emotional exhaustion and the average value of low sense of achievement are relatively close in the direction of English learning burnout, which are larger than that in the other two directions. The three directions in English learning burnout are positively correlated with each other. The three directions in English learning engagement are positively correlated with those of psychological needs. Besides, there is an obvious positive correlation between the three directions of English learning engagement with teachers’ autonomy support (p &lt; 0.01). However, the three directions in teachers’ autonomy support and the three directions in psychological needs are all negatively correlated with English learning burnout (p &lt; 0.01). To sum up, the psychological needs of middle school students are effectively met, and teachers’ autonomy support can obviously promote the effectiveness and engagement of middle school students’ English learning.

The article “Application of Virtual Reality Technology in Disaster Medicine”, written by Yu-yu DUAN, Jia-yao ZHANG, Mao XIE, Xiao-bo FENG, Song XU, Zhe-wei YE, was originally published electronically on the publisher’s internet portal on October 2019 without open access. With the author(s)’ decision to opt for Open Choice, the copyright of the article is changed to © The Author(s) 2020 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The original article has been corrected.Corresponding author: Zhe-wei YE

Ethnopharmacology relevance: Yunnan Baiyao (YNBY), a traditional Chinese medicine formulae, has some significant properties including activating blood circulation to dissipate blood stasis (Huo-Xue-Hua-Yu), eliminating swelling and alleviating pain (Xiao-Zhong-Zhi-Tong), and eliminating necrotic tissues and promoting granulation (Qu-Fu-Sheng-Ji).Aim of this study: This paper intends to provide a comprehensive and critical analysis of studies on YNBY, proposing new possible therapeutic directions of this formula.Materials and methods: Relevant data on YNBY were retrieved from available databases and a hand-search by searching the keywords such as “Yunnan Baiyao,” “pharmacology,” “toxicity,” and “clinical applications.”Results: Traditionally, YNBY has been used to cure hemorrhage, bruises, swelling, and pain caused by injuries in the Chinese folk. Modern pharmacological studies show that YNBY possesses pharmacological activities including hemostasis, invigorating the circulation of blood, wound healing, anti-inflammation, analgesia, antibiosis, infection prevention, and other effects. Toxicological studies demonstrate that YNBY has a certain toxicology, which is mainly caused by Aconitum alkaloids from Cao-wu (CW, Aconiti Kusnezoffii Radix). The developmental non-toxic reaction dose (NOAEL) of YNBY for embryos and fetuses is 0.5 g/kg in rats. In addition, the NOAEL for fertility and early embryo development toxicity is 4.0 g/kg in rats. Clinical trials have confirmed the safety of YNBY in a large number of patients, and adverse drug reactions (ADRs) such as abdominal pain, diarrhea, allergy, and others in very few people. YNBY is routinely used in clinic to cure bleeding, pain, swelling, upper digestive tract ulcer, postoperative wound, arthritis, mouth ulcers, ulcerative colitis, etc.Conclusions: Hemostasis is a conspicuous effect of YNBY. Except for this effect, analgesia and anti-infection may be new research directions of this formula. In addition, the in vitro and in vivo pharmacology and mechanisms of action of YNBY are encouraged as well as the pharmacokinetics of this formulae. Furthermore, the material basis of the pharmacological effects of YNBY also needs clear identification.

Introdução: A transmissão SARS-CoV-2 de humano para humano pode ocorrer e o risco de propagação no ar durante os procedimentos odontológicos geradores de aerossóis permanece uma preocupação. Acredita-se que um enxaguatório bucal antimicrobiano pré-operacional reduza o número de micróbios orais. No entanto, a eficácia do enxaguatório bucal pré-procedimento na redução do número de microrganismos disseminados por meio do aerossol gerado por procedimentos odontológicos ainda não está clara. Objetivo: avaliar através de uma revisão de literatura o uso de enxaguantes bucais na redução da carga viral do SARS-CoV-2. Materiais e Método: O levantamento literário para esta pesquisa foi realizado no período de dezembro de 2019 a 10 de agosto de 2020 nas bases de dados Scielo e Medline/PubMed. Na estratégia de busca, foram utilizadas as palavras “SARS-CoV-2”, “2019-nCoV”, “COVID-19”, “Dentistry”, “Odontologia”, “Odontología”, “Mouthwashes”, “Antissépticos Bucais” e “Antisépticos Bucales”. Resultados: Uma busca sistematizada foi realizada, foram encontrados 661 artigos, após a realização da leitura criteriosa dos artigos completos foram selecionados 42 artigos. 88% dos estudos indicavam o uso de Peróxido de hidrogênio a 1%, 76% indicavam Povidine 0,2% e apenas 19% o uso da Clorexidina a 0,12%. Conclusão: Os estudos presentes na literatura apresentam divergências nas indicações e porcentagens dos enxaguantes indicados. Os protocolos clínicos devem ser avaliados para reduzir o risco de transmissão e proteger pacientes e profissionais.Descritores: Infecções por Coronavírus; Betacoronavirus; Odontologia; Antissépticos Bucais.ReferênciasGe ZY, Yang LM, Xia JJ, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020;21(5):361-68. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. 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Br J Oral Maxillofac Surg. 2020;58(6):687-91.Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19: Changing Trends and Its Impact on Future of Dentistry. Int J Dent. 2020;2020:8817424.Cabrera-Tasayco FDP, Rivera-Carhuavilca JM, Atoche-Socola KJ, Pena-Soto C, Arriola-Guillen LE. Biosafety measures at the dental office after the appearance of COVID-19: A systematic review. Disaster Med Public Health Prep. 2020:1-16. Carrouel F, Conte MP, Fisher J, et al. COVID-19: A Recommendation to Examine the Effect of Mouthrinses with beta-Cyclodextrin Combined with Citrox in Preventing Infection and Progression. J Clin Med. 2020;9(4):1126.Chen W, Wang Q, Li YQ, Yu HL, Xia YY, Zhang ML, et al. [Early containment strategies and core measures for prevention and control of novel coronavirus pneumonia in China]. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54(3):239-44.Duruk G, Gumusboga ZS, Colak C. Investigation of Turkish dentists' clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study. Braz Oral Res. 2020;34:e054.Baghizadeh Fini M. What dentists need to know about COVID-19. Oral Oncol. 2020;105:104741.Guiñez-Coelho, M. Impacto del COVID-19 (SARS-CoV-2) a Nivel Mundial, Implicancias y Medidas Preventivas en la Práctica Dental y sus Consecuencias Psicológicas en los Pacientes. Int. J. Odontostomat. 2020;14(3):271-78.Guo Y, Jing Y, Wang Y, To A, Du S, Wang L,et al. Control of SARS-CoV-2 transmission in orthodontic practice. Am J Orthod Dentofacial Orthop. 2020;S0889-5406(20):30307-3.Gurzawska-Comis K, Becker K, Brunello G, Gurzawska A, Schwarz F. Recommendations for Dental Care during COVID-19 Pandemic. J Clin Med. 2020;9(6):1833.Ilyas N, Agel M, Mitchell J, Sood S. COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry. Br Dent J. 2020; 228(12):927-3.Jamal M, Shah M, Almarzooqi SH, Aber H, Khawaja S, El Abed, et al. Overview of transnational recommendations for COVID-19 transmission control in dental care settings. Oral Dis. 2020.10.1111/odi.13431.Jotz GP, Voegels RL, Bento RF. Otorhinolaryngologists and Coronavirus Disease 2019 (COVID-19). Int. Arch. Otorhinolaryngol. 2020;24(2):125-28.Kerawala C, Riva F. Aerosol-generating procedures in head and neck surgery - can we improve practice after COVID-19? Br J Oral Maxillofac Surg. 2020;58(6):704-7.Koutras S, Govender S, Wood NH, Motloba PD. COVID-19 pandemic and the dental practice. S. Afr. dent. j. 2020;75(3):119-25. Lo Giudice R. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice. Int J Environ Res Public Health. 2020;17(9):3067.Long RH, Ward TD, Pruett ME, Coleman JF, Plaisance MC, Jr. Modifications of emergency dental clinic protocols to combat COVID-19 transmission. Spec Care Dentist. 2020;40(3):219-26.Martins-Chaves RR, Gomes CC, Gomez RS. Immunocompromised patients and coronavirus disease 2019: a review and recommendations for dental health care. Braz Oral Res. 2020;34:e048.Naqvi K, Mubeen SM, Ali Shah SM. Challenges in providing oral and dental health services in COVID-19 pandemic. J Pak Med Assoc. 2020;70(Suppl 3)(5):S113-17.Passarelli PC, Rella E, Manicone PF, Garcia-Godoy F, D'Addona A. The impact of the COVID-19 infection in dentistry. Exp Biol Med (Maywood). 2020;245(11):940-44.Patil S, Moafa IH, Bhandi S, Jafer MA, Khan SS, Khan S,et al. Dental care and personal protective measures for dentists and non-dental health care workers. Dis Mon. 2020;101056.Peditto M, Scapellato S, Marciano A, Costa P, Oteri G. Dentistry during the COVID-19 Epidemic: An Italian Workflow for the Management of Dental Practice. Int J Environ Res Public Health. 2020;17(9):3325.Romero MR. Guía de buenas prácticas en Odontología para Uruguay durante la pandemia Covid-19. 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Introdução: O câncer é definido como uma proliferação descontrolada de células malignas em um hospedeiro e considerado uma das principais causas de morte em todo o mundo. No Brasil, o câncer colorretal é a segunda causa de morte mais comum entre mulheres e a terceira mais prevalente em homens. Muitas estratégias têm sido estudadas para auxiliar o tratamento antineoplásico. Dentro desse contexto, a ingestão de probióticos, representa uma nova opção terapêutica relevante no âmbito da nutrição. Objetivo: Realizar uma revisão sobre o uso dos probióticos no tratamento de pacientes com câncer colorretal. Material e Método: Trata-se de uma revisão realizada em 2018, utilizando-se 10 artigos, pesquisados nas bases indexadas BVS e PubMed e na ferramenta de pesquisa Google acadêmico. A pesquisa incluiu artigos em português e inglês publicados no período de 2010 a 2017. Resultados: O uso de probióticos demonstrou trazer efeitos positivos ao tratamento de pacientes com câncer colorretal, trazendo benefícios como: a diminuição de enterobactérias e enterococos, melhora na modulação da imunidade local, melhora dos sintomas intestinais, recuperação da função intestinal, entre outros. Conclusão: Conclui-se que apesar dos resultados positivos observados, há a necessidade de futuros estudos de longa duração para elucidar melhor essa relação.Descritores: Neoplasias Colorretais; Nutrientes; Probióticos.ReferênciasKahouli I, Malhotra M, Westfall S, Alaoui-Jamali MA, Prakash S. Design and validation of an orally administrated active L. fermentum-L. acidophilus probiotic formulation using colorectal cancer Apc Min/+ mouse model. Appl Microbiol Biotechnol. 2017;101(5):1999-2019.Oliveira RC, Rêgo MAV. Mortality risck of colorectal câncer in Brazil from 1980 to 2013. Arq Gastroenterol 2016;53(2)76-83.Instituto Nacional de Câncer (INCA). Tipos de câncer: colorretal. 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Qualidade de vida do paciente com câncer colorretal em quimioterapia ambulatorial. Rev Gaucha Enferm. 2011;32(4):767-73.Barbosa, LRLS. Perfil nutricional de pacientes em pré-operatório eletivo para câncer colorretal [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2011.Denipote FG, Trindade EBSM, Burini RC. Probióticos e Prebióticos na atenção primária ao câncer de cólon. Arq Gastroenterol. 2010;47(1):93-8.Machado FF, Lazzaretti RK, Poziomyck AK. Uso de prebióticos, probióticos e simbióticos nos pré e pós- operatórios do câncer colorretal: uma revisão. Rev bras cancerol. 2014;60(4):363-70.Correia MITD, Liboredo JC, Consoli MLD. The role of probiotics in gastrointestinal surgery. Nutrition. 2012;28(3):230-34.Zhang JW, Du P, Gao J, Yang BR, Fang WJ, Ying CM. Preoperative probiotics decrease postoperative infectious complications of colorectal cancer. Am J Med Sci. 2012;343(3):199-205.Liu Z, Qin H, Yang Z, Xia Y, Liu W, Yang J et al. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and postoperative infectious complications in colorectal câncer surgery – a double-blind study. Aliment Pharmacol Ther. 2011;33(1):50-63.Yang Y, Xia Y, Chen H, Hong L, Feng J, Yang J et al. The effect of perioperative probiotics treatment for colorectal cancer: short-term outcomes of a randomized controlled trial. Oncotarget. 7(7);8432-40.Kotzampassi K, Stavrou G, Damoraki G, Georgitsi M, Basdanis G, Tsaousi G et al. A four-Probiotics regimen reduces postoperative complications after colorectal surgery: a randomized, double-blind, placebo-controlled study. World J Surg. 2015;39(11):2776-83.Lee JY, Chu SH, Jeon JY, Lee MK, Park JH, Lee DC et al. Effects of 12 weeks of probiotic supplementation on quality of life in colorectal cancer survivors: a double-blind, randomized, placebo-controlled trial. Dig Liver Dis. 2014;46(12):1126-32.Gianotti L, Morelli L, Galbiati F, Rocchetti S, Coppola S, Beneduce A. A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients. World J Gastroenterol. 2010;16(2):167-75.Stephens JH, Hewett PJ. Clinical trial assessing VSL#3 for the treatment of anterior resection syndrome. ANZ J Surg. 2012;82(6):420-27.Xia Y, Yang Z, Chen HQ, Qin HL. Effect of bowel preparation with probiotics on intestinal barrier after surgery for colorectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2010;13:528-31.Zhu D, Chen X, Wu J, Ju Y, Feng J, Lu G, et al. Effect of perioperative intestinal probiotics on intestinal flora and immune function in patients with colorectal cancer. Nan Fang Yi Ke Da Xue Xue Bao. 2012;32(8):1190-93.Derrien M, Van Hilckama Vlieg JE. Fate, activity, and impact of ingested bacteria within the human gut microbiota. Trends Microbiol. 2015;23(6):354-366.Gaudier E, Michel C, Segain JP, Cherbut C, Hoebler C. The VSL#3 probiotic mixture modifies microflora but does not heal chronic dextran-sodium sulfateinduced colitis or reinforce the mucus barrier in mice. J Nutr. 2005;135(12):2753-61.Mego M, Chovanec J, Vochyanova-Andrezalova I, Konkolovsky P, Mikulova M, Reckova M et al. Prevention of irinotecan induced diarrhea by probiotics: a randomized double blind, placebo controlled pilot study. Complement Ther Med. 2015;23(3):356-62.Yang Y, Xia Y, Chen H, Hong L, Feng J, Yang J et al. The effect of perioperative probiotics treatment for colorectal cancer: short-term outcomes of a randomized controlled trial. Oncotarget. 2016;7(7):8432-40.

Abstract: The study aims to provide evidence of double nutritional burden (including malnutrition and overweight/obesity) as well as the impact of eating habits on nutritional status of preschool children at Nam Hong commune, Dong Anh district, Hanoi. Subjects of study: children aged from 24 to 60 months old at 2 preschools of Nam Hong commune. The study is divided into 2 phases: at the phase 1: a cross sectional study was applied to 1593 children; at the phase 2: a matched case-control study was applied in order to analyze effects of eating habits to nutritional status of children (1 malnourished child / 5 normal children and 1 obese overweight child / 5 normal children, matched pairs in age, sex, class). Research results: the percentage of children with normal nutritional status is 86.8%, however, Nam Hong still suffer a double burden of nutrition when the rate of malnourished children is still high (accounting for 4.2%) and overweight/obesity children is 9.0%, in which the rate of overweight and obesity children in boys is higher than girls (10.9% compared with 6.7%, respectively). Eating characteristics affect malnutrition status of children including: loss appetite (OR=4.3), slowness in eating (OR=2.23), enjoyment of food score (OR=0.69), desire to drink score (OR=0.82). Eating characteristics affect the overweight/obesity child’s include: appetite characteristics (OR=4.24), loss appetite (OR=0.43), fast eating (OR=2.56), slowness eating (OR=0.43), eating more (OR=6.78), eating less (OR=0.31), prefer fat (OR=2.18), food responsiveness score (OR=1.59), enjoyment of food score (OR=1.8), satiety responsiveness score (OR=0.51), slowness in eating score (OR=0.05), emotional under eating score (OR=0.67), food fussioness score (OR=0.72). Keywords Double burdens, malnutrition, overweight/obesity, Nam Hong commune, Dong Anh. References [1] L.T. Huong, N.T. Linh, N.T.T. Ha, Nutritional status and cognitive development of children under 6 in urban, rural and mountainous area of the north in 2012, Journal of Food and Nutrition Sciences 10 (2014) 67-74 (in Vietnamese). http://viendinhduong.vn/research/detail?id=620&catName=cac-de-tai-va-xuat-ban-pham&lang=vi[2] N.T.T. Thu, L.T. Tuyet, Anthropometric characteristics and nutritional status in 24 - 59 months children in Hanoi city, Thanh Hoa province and Phu Tho province in 2018, HNUE Journal of Science, Natural Sciences 3 (2018) 150-157. (in Vietnamese). https://doi.org/10.18173/2354-1059.2018-0016. http://stdb.hnue.edu.vn/portal/journals.php?articleid=5149.[3] N.T.T. Thu, L.T.T. Dung, L.T Tuyet, Nutritional status: the trends of preschool children aged 10–60 months in the north of Vietnam, Health Risk Analysis 4 (2018). https://doi.org/10.21668/health.risk/2018.4.06.eng[4] N.H. Trang, T.K. Hong, M.J. Dibley, Cohort profile: Ho Chi Minh City Youth Cohortdchanges in diet, physical activity, sedentary behaviour and relationship with overweight/obesity in adolescents, BMJ Open 2 (2012) e000362. https://doi.org/10.1136/bmjopen-2011-000362. http://dx.doi.org/10.1136/bmjopen-2011-000362[5] WHO, fact sheet, 2019. Infant and young child feeding, http://www.who.int/mediacentre/factsheets/fs342/en/ (accessed 6/2019). [6] WHO, Childhood overweight and obesity, 2019. https://www.who.int/dietphysicalactivity/childhood/en/ (accessed 6/2019).[7] J.M. Braun, H.J. Kalkwarf, G.D. Papandonatos, A. Chen, B.P. Lanphear, Patterns of early life body mass index and childhood overweight and obesity status at eight years of age, BMC Pediatr 18 (2018) 161. https://doi.org/10.1186/s12887-018-1124-9.[8] L.T. Tuyet, B.T. Nhung, T.Q. Binh, Association of neonatal, breastfeeding, eating behavior characteristics with obesity in primary school children in Hanoi urban areas, VNU Journal of Science: Natural Sciences and Technology 30 (2014) 275-281. (in Vietnamese). [9] L. Webber, C. Hill, J. Saxton, C.H. Van Jaarsveld, J. Wardle, Eating behaviour and weight in children, Int J Obes (Lond). 33 (2009) 21-28. https://doi.org/10.1038/ijo.2008.219.[10] A. Meule, A.P. Lutz, C. Vogele, A. Kubler, Impulsive reactions to food-cues predict subsequent food craving. Eat Behav 14 (2014) 99-105. https://doi.org/10.1016/j.eatbeh.2013.10.023.[11] WHO, Anthro Plus for Personal Computers Manual: Software for Assessing Growth of the World’s Children and Adolescents. Geneva, Switzerland: World Health Organization. http://www.who.int/growthref/tools/en/ (accessed 3/2019).[12] J. Wardle, C.A. Guthrie, S. Sanderson, L. Rapopor, Development of the Children's Eating Behaviour Questionnaire. J Child Psychol Psychiatry 42 (2001) 963-970. https://doi.org/10.1111/1469-7610.00792.[13] Vietnam National Institute of Nutrition, UNICEF, Alive and Thrive, Nutrition monitoring information 2013, Hanoi, Vietnam (2014).[14] UNICEF. Undernutrition contributes to nearly half of all deaths in children under 5 and is widespread in Asia and Africa 2019. 2019. https://data.unicef.org/topic/nutrition/malnutrition/# (accessed 3/2019).[15] M. de Onis, E. Borghi, M. Arimond, P. Webb, T. Croft, K. Saha, et al., Prevalence thresholds for wasting, overweight and stunting in children under 5 years, Public Health Nutr 22 (2019) 175-179. https://doi.org/10.1017/S1368980018002434.[16] A. Ek, K. Sorjonen, K. Eli, L. Lindberg, J. Nyman, C. Marcus, P. Nowicka, Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist, PLoS One 22 (2016) e0147257. https://doi.org/10.1371/journal.pone.0147257.[17] J. Zhang, Y. Zhai, X.Q. Feng, W.R. Li, Y.B. Lyu, T. Astell-Burt, P.Y. Zhao, X.M. Shi, Gender differences in the prevalence of overweight and obesity, associated behaviors, and weight-related perceptions in a National Survey of Primary School Children in China, Biomed Environ Sci 31 (2018) 1-11. https://doi.org/10.3967/bes2018.001.[18] V.H.C. Wang, J. Min, H. Xue, S. Du, F. Xu, H. Wang, Y. Wang, Factors contributing to sex differences in childhood obesity prevalence in China, Public Health Nutr 21 (2018) 2056-2064. https://doi.org/10.1017/S1368980018000290.[19] H. Ochiai, T. Shirasawa, R. Nishimura, A. Morimoto, N. Shimada, T. Ohtsu, M. Hashimoto, H. Hoshino, N. Tajima, A. Kokaze, Eating behavior and childhood overweight among population-based elementary school children in Japan, Int J Environ Res Public Health 9 (2012) 1398-1410. https://doi.org/10.3390/ijerph9041398.[20] L.T. Tuyet, B.T Nhung, T.Q Binh, Association of some eating behaviour characteristics and sedentary lifestyle with obesity among Hanoi primary school boy in 2012, VNU Journal of Science: Natural Sciences and Technology 31 (2), 60-66 (in Vietnamese). https://js.vnu.edu.vn/NST/article/view/76.[21] W. Labree W., D. van de Mheen, F. Rutten, G. Rodenburg, G. Koopmans, M. Foets, Differences in Overweight and Obesity among Children from Migrant and Native Origin: The Role of Physical Activity, Dietary Intake, and Sleep Duration, PLoS One 10 (2015) e0123672. https://doi.org/10.1371/journal.pone.0123672.[22] S. Kar, B. Khandelwal, Fast foods and physical inactivity are risk factors for obesity and hypertension among adolescent school children in east district of Sikkim, India, J Nat Sci Biol Med 6 (2015) 356-359. https://doi.org/10.4103/0976-9668.160004.[23] J.L. Santos, J.A. Ho-Urriola, A. Gonzalez, S.V. Smalley, P. Dominguez-Vasquez, R. Cataldo, Association between eating behavior scores and obesity in Chilean children, Nutr J. 10 (2011) 108. https://doi.org/10.1186/1475-2891-10-108.[24] J.C. Spence, V. Carson, L. Casey, N. Boule, Examining behavioural susceptibility to obesity among Canadian pre-school children: the role of eating behaviours, Int J Pediatr Obes 6 (2011) e501–7. https://doi.org/10.3109/17477166.2010.512087.[25] Y.T. Cao, V. Svensson, C. 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The curtain rose. The howling of desert wind filled the performance hall in the Shanghai Grand Theatre. Into the center stage, where a scenic construction of a mountain cliff and a desert landscape was dimly lit, entered the character of the Daoist priest Wang Yuanlu (1849–1931), performed by Chen Yizong. Dressed in a worn and dusty outfit of dark blue cotton, characteristic of Daoist priests, Wang began to sweep the floor. After a few moments, he discovered a hidden chambre sealed inside one of the rock sanctuaries carved into the cliff.Signaled by the quick, crystalline, stirring wave of sound from the chimes, a melodious Chinese ocarina solo joined in slowly from the background. Astonished by thousands of Buddhist sūtra scrolls, wall paintings, and sculptures he had just accidentally discovered in the caves, Priest Wang set his broom aside and began to examine these treasures. Dawn had not yet arrived, and the desert sky was pitch-black. Priest Wang held his oil lamp high, strode rhythmically in excitement, sat crossed-legged in a meditative pose, and unfolded a scroll. The sound of the ocarina became fuller and richer and the texture of the music more complex, as several other instruments joined in.Below is the opening scene of the award-winning, theatrical dance-drama Dunhuang, My Dreamland, created by China’s state-sponsored Lanzhou Song and Dance Theatre in 2000. Figure 1a: Poster Side A of Dunhuang, My Dreamland Figure 1b: Poster Side B of Dunhuang, My DreamlandThe scene locates the dance-drama in the rock sanctuaries that today are known as the Dunhuang Mogao Caves, housing Buddhist art accumulated over a period of a thousand years, one of the best well-known UNESCO heritages on the Silk Road. Historically a frontier metropolis, Dunhuang was a strategic site along the Silk Road in northwestern China, a crossroads of trade, and a locus for religious, cultural, and intellectual influences since the Han dynasty (206 B.C.E.–220 C.E.). Travellers, especially Buddhist monks from India and central Asia, passing through Dunhuang on their way to Chang’an (present day Xi’an), China’s ancient capital, would stop to meditate in the Mogao Caves and consult manuscripts in the monastery's library. At the same time, Chinese pilgrims would travel by foot from China through central Asia to Pakistan, India, Nepal, Bangladesh, and Sri Lanka, playing a key role in the exchanges between ancient China and the outside world. Travellers from China would stop to acquire provisions at Dunhuang before crossing the Gobi Desert to continue on their long journey abroad. Figure 2: Dunhuang Mogao CavesThis article approaches the idea of “abroad” by examining the present-day imagination of journeys along the Silk Road—specifically, staged performances of the various Silk Road journey-themed dance-dramas sponsored by the Chinese state for enhancing its cultural and foreign policies since the 1970s (Kuang).As ethnomusicologists have demonstrated, musicians, choreographers, and playwrights often utilise historical materials in their performances to construct connections between the past and the present (Bohlman; Herzfeld; Lam; Rees; Shelemay; Tuohy; Wade; Yung: Rawski; Watson). The ancient Silk Road, which linked the Mediterranean coast with central China and beyond, via oasis towns such as Samarkand, has long been associated with the concept of “journeying abroad.” Journeys to distant, foreign lands and encounters of unknown, mysterious cultures along the Silk Road have been documented in historical records, such as A Record of Buddhist Kingdoms (Faxian) and The Great Tang Records on the Western Regions (Xuanzang), and illustrated in classical literature, such as The Travels of Marco Polo (Polo) and the 16th century Chinese novel Journey to the West (Wu). These journeys—coming and going from multiple directions and to different destinations—have inspired contemporary staged performance for audiences around the globe.Home and Abroad: Dunhuang and the Silk RoadDunhuang, My Dreamland (2000), the contemporary dance-drama, staged the journey of a young pilgrim painter travelling from Chang’an to a land of the unfamiliar and beyond borders, in search for the arts that have inspired him. Figure 3: A scene from Dunhuang, My Dreamland showing the young pilgrim painter in the Gobi Desert on the ancient Silk RoadFar from his home, he ended his journey in Dunhuang, historically considered the northwestern periphery of China, well beyond Yangguan and Yumenguan, the bordering passes that separate China and foreign lands. Later scenes in Dunhuang, My Dreamland, portrayed through multiethnic music and dances, the dynamic interactions among merchants, cultural and religious envoys, warriors, and politicians that were making their own journey from abroad to China. The theatrical dance-drama presents a historically inspired, re-imagined vision of both “home” and “abroad” to its audiences as they watch the young painter travel along the Silk Road, across the Gobi Desert, arriving at his own ideal, artistic “homeland”, the Dunhuang Mogao Caves. Since his journey is ultimately a spiritual one, the conceptualisation of travelling “abroad” could also be perceived as “a journey home.”Staged more than four hundred times since it premiered in Beijing in April 2000, Dunhuang, My Dreamland is one of the top ten titles in China’s National Stage Project and one of the most successful theatrical dance-dramas ever produced in China. With revenue of more than thirty million renminbi (RMB), it ranks as the most profitable theatrical dance-drama ever produced in China, with a preproduction cost of six million RMB. The production team receives financial support from China’s Ministry of Culture for its “distinctive ethnic features,” and its “aim to promote traditional Chinese culture,” according to Xu Rong, an official in the Cultural Industry Department of the Ministry. Labeled an outstanding dance-drama of the Chinese nation, it aims to present domestic and international audiences with a vision of China as a historically multifaceted and cosmopolitan nation that has been in close contact with the outside world through the ancient Silk Road. Its production company has been on tour in selected cities throughout China and in countries abroad, including Austria, Spain, and France, literarily making the young pilgrim painter’s “journey along the Silk Road” a new journey abroad, off stage and in reality.Dunhuang, My Dreamland was not the first, nor is it the last, staged performances that portrays the Chinese re-imagination of “journeying abroad” along the ancient Silk Road. It was created as one of many versions of Dunhuang bihua yuewu, a genre of music, dance, and dramatic performances created in the early twentieth century and based primarily on artifacts excavated from the Mogao Caves (Kuang). “The Mogao Caves are the greatest repository of early Chinese art,” states Mimi Gates, who works to increase public awareness of the UNESCO site and raise funds toward its conservation. “Located on the Chinese end of the Silk Road, it also is the place where many cultures of the world intersected with one another, so you have Greek and Roman, Persian and Middle Eastern, Indian and Chinese cultures, all interacting. Given the nature of our world today, it is all very relevant” (Pollack). As an expressive art form, this genre has been thriving since the late 1970s contributing to the global imagination of China’s “Silk Road journeys abroad” long before Dunhuang, My Dreamland achieved its domestic and international fame. For instance, in 2004, The Thousand-Handed and Thousand-Eyed Avalokiteśvara—one of the most representative (and well-known) Dunhuang bihua yuewu programs—was staged as a part of the cultural program during the Paralympic Games in Athens, Greece. This performance, as well as other Dunhuang bihua yuewu dance programs was the perfect embodiment of a foreign religion that arrived in China from abroad and became Sinicized (Kuang). Figure 4: Mural from Dunhuang Mogao Cave No. 45A Brief History of Staging the Silk Road JourneysThe staging of the Silk Road journeys abroad began in the late 1970s. Historically, the Silk Road signifies a multiethnic, cosmopolitan frontier, which underwent incessant conflicts between Chinese sovereigns and nomadic peoples (as well as between other groups), but was strongly imbued with the customs and institutions of central China (Duan, Mair, Shi, Sima). In the twentieth century, when China was no longer an empire, but had become what the early 20th-century reformer Liang Qichao (1873–1929) called “a nation among nations,” the long history of the Silk Road and the colourful, legendary journeys abroad became instrumental in the formation of a modern Chinese nation of unified diversity rooted in an ancient cosmopolitan past. The staged Silk Road theme dance-dramas thus participate in this formation of the Chinese imagination of “nation” and “abroad,” as they aestheticise Chinese history and geography. History and geography—aspects commonly considered constituents of a nation as well as our conceptualisations of “abroad”—are “invariably aestheticized to a certain degree” (Bakhtin 208). Diverse historical and cultural elements from along the Silk Road come together in this performance genre, which can be considered the most representative of various possible stagings of the history and culture of the Silk Road journeys.In 1979, the Chinese state officials in Gansu Province commissioned the benchmark dance-drama Rain of Flowers along the Silk Road, a spectacular theatrical dance-drama praising the pure and noble friendship which existed between the peoples of China and other countries in the Tang dynasty (618-907 C.E.). While its plot also revolves around the Dunhuang Caves and the life of a painter, staged at one of the most critical turning points in modern Chinese history, the work as a whole aims to present the state’s intention of re-establishing diplomatic ties with the outside world after the Cultural Revolution. Unlike Dunhuang, My Dreamland, it presents a nation’s journey abroad and home. To accomplish this goal, Rain of Flowers along the Silk Road introduces the fictional character Yunus, a wealthy Persian merchant who provides the audiences a vision of the historical figure of Peroz III, the last Sassanian prince, who after the Arab conquest of Iran in 651 C.E., found refuge in China. By incorporating scenes of ethnic and folk dances, the drama then stages the journey of painter Zhang’s daughter Yingniang to Persia (present-day Iran) and later, Yunus’s journey abroad to the Tang dynasty imperial court as the Persian Empire’s envoy.Rain of Flowers along the Silk Road, since its debut at Beijing’s Great Hall of the People on the first of October 1979 and shortly after at the Theatre La Scala in Milan, has been staged in more than twenty countries and districts, including France, Italy, Japan, Thailand, Russia, Latvia, Hong Kong, Macao, Taiwan, and recently, in 2013, at the Lincoln Center for the Performing Arts in New York.“The Road”: Staging the Journey TodayWithin the contemporary context of global interdependencies, performing arts have been used as strategic devices for social mobilisation and as a means to represent and perform modern national histories and foreign policies (Davis, Rees, Tian, Tuohy, Wong, David Y. H. Wu). The Silk Road has been chosen as the basis for these state-sponsored, extravagantly produced, and internationally staged contemporary dance programs. In 2008, the welcoming ceremony and artistic presentation at the Olympic Games in Beijing featured twenty apsara dancers and a Dunhuang bihua yuewu dancer with long ribbons, whose body was suspended in mid-air on a rectangular LED extension held by hundreds of performers; on the giant LED screen was a depiction of the ancient Silk Road.In March 2013, Chinese president Xi Jinping introduced the initiatives “Silk Road Economic Belt” and “21st Century Maritime Silk Road” during his journeys abroad in Kazakhstan and Indonesia. These initiatives are now referred to as “One Belt, One Road.” The State Council lists in details the policies and implementation plans for this initiative on its official web page, www.gov.cn. In April 2013, the China Institute in New York launched a yearlong celebration, starting with "Dunhuang: Buddhist Art and the Gateway of the Silk Road" with a re-creation of one of the caves and a selection of artifacts from the site. In March 2015, the National Development and Reform Commission (NDRC), China’s top economic planning agency, released a new action plan outlining key details of the “One Belt, One Road” initiative. Xi Jinping has made the program a centrepiece of both his foreign and domestic economic policies. One of the central economic strategies is to promote cultural industry that could enhance trades along the Silk Road.Encouraged by the “One Belt, One Road” policies, in March 2016, The Silk Princess premiered in Xi’an and was staged at the National Centre for the Performing Arts in Beijing the following July. While Dunhuang, My Dreamland and Rain of Flowers along the Silk Road were inspired by the Buddhist art found in Dunhuang, The Silk Princess, based on a story about a princess bringing silk and silkworm-breeding skills to the western regions of China in the Tang Dynasty (618-907) has a different historical origin. The princess's story was portrayed in a woodblock from the Tang Dynasty discovered by Sir Marc Aurel Stein, a British archaeologist during his expedition to Xinjiang (now Xinjiang Uygur autonomous region) in the early 19th century, and in a temple mural discovered during a 2002 Chinese-Japanese expedition in the Dandanwulike region. Figure 5: Poster of The Silk PrincessIn January 2016, the Shannxi Provincial Song and Dance Troupe staged The Silk Road, a new theatrical dance-drama. Unlike Dunhuang, My Dreamland, the newly staged dance-drama “centers around the ‘road’ and the deepening relationship merchants and travellers developed with it as they traveled along its course,” said Director Yang Wei during an interview with the author. According to her, the show uses seven archetypes—a traveler, a guard, a messenger, and so on—to present the stories that took place along this historic route. Unbounded by specific space or time, each of these archetypes embodies the foreign-travel experience of a different group of individuals, in a manner that may well be related to the social actors of globalised culture and of transnationalism today. Figure 6: Poster of The Silk RoadConclusionAs seen in Rain of Flowers along the Silk Road and Dunhuang, My Dreamland, staging the processes of Silk Road journeys has become a way of connecting the Chinese imagination of “home” with the Chinese imagination of “abroad.” Staging a nation’s heritage abroad on contemporary stages invites a new imagination of homeland, borders, and transnationalism. Once aestheticised through staged performances, such as that of the Dunhuang bihua yuewu, the historical and topological landscape of Dunhuang becomes a performed narrative, embodying the national heritage.The staging of Silk Road journeys continues, and is being developed into various forms, from theatrical dance-drama to digital exhibitions such as the Smithsonian’s Pure Land: Inside the Mogao Grottes at Dunhuang (Stromberg) and the Getty’s Cave Temples of Dunhuang: Buddhist Art on China's Silk Road (Sivak and Hood). 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