The most dreadful mushroom toxins: a review of their toxicological mechanisms, chemical structural characteristics, and treatment.

Mushroom consumption is a worldwide custom that continues to grow in popularity. On the other hand, foraging for wild mushrooms can lead to serious disease and even death if deadly mushrooms are accidentally consumed. Mushroom poisoning is difficult to diagnose and treat since the symptoms are similar to those of other disorders. In terms of chemistry, mushroom poisoning is associated with extraordinarily strong toxins, meaning that isolating and identifying toxins has substantial scientific relevance, especially in understanding the lethal components of toxic mushrooms. Most of these toxins exhibit exceptional physiological features that might help enhance chemistry, biochemistry, physiology, and pharmacology research. Despite the discovery of more than 100 poisons, several dangerous mushrooms remain unexplored. This review covers the chemistry (including chemical structures, complete synthesis, and biosynthesis), as well as the toxicology, namely the toxicokinetics, mechanisms of toxicology, and clinical toxicology of these poisons, in addition to the discussion of the development of their most effective diagnostic and therapeutic strategies with the hopes of spurring additional studies, focusing on individual classes of toxins found in poisonous mushrooms such as amatoxins, gyromitrin, orellanine, and phallatoxins. See also the graphical abstract(Fig. 1).

Multidrug-Resistant Escherichia coli Accumulated by Freshwater Bivalves: An Underestimated Risk for Public Health?

As bioindicators, freshwater bivalves are crucial for the assessment of the contamination impact on different levels of biological integration. Escherichia coli is used as a bioindicator of water fecal contamination, representing a critical global concern, especially with the rise of multidrug-resistant (MDR) strains. Phylogenetic diversity, pathotypic characterization, and antibiotic resistance profiles of E. coli isolated from freshwater bivalves (Anodonta anatina) were assessed. Samples were collected from the Tua River in Northern Portugal, from two different sites, Chelas and Barcel, representing different degrees of contamination. Antimicrobial susceptibility testing was performed by the disk diffusion method, and characterizations of the phylogenetic groups and pathotypes were assessed by PCR-multiplex and real-time PCR-multiplex, respectively. Results showed that 60% of isolates were characterized as MDR, including resistance to carbapenems, considered the last resort against multidrug-resistant bacteria. Within this study, it was also possible to verify the antimicrobial resistance (AMR) profile differences between the two sampling sites, with bivalve isolates from the Chelas site showing a higher percentage of antibiotic resistance. Among the E. coli isolates, the highest prevalence (55%) was observed in group B1, followed by group D or E (15%), group A (10%), and group E or Clade I (10%). None of the isolates were classified as diarrheagenic E. coli (DEC). This work highlights the potential transmission of antimicrobial-resistant bacteria through bivalves in the food chain. The 'One Health' approach is crucial for combating antimicrobial resistance, namely in edible freshwater species, emphasizing active surveillance to protect human, animal, and environmental health against the spread of antibiotic-resistant bacteria in aquatic environments.

Establishment of a high-content compatible platform to assess effects of monocyte-derived factors on neural stem cell proliferation and differentiation.

During neuroinflammation, monocytes that infiltrate the central nervous system (CNS) may contribute to regenerative processes depending on their activation status. However, the extent and mechanisms of monocyte-induced CNS repair in patients with neuroinflammatory diseases remain largely unknown, partly due to the lack of a fully human assay platform that can recapitulate monocyte-neural stem cell interactions within the CNS microenvironment. We therefore developed a human model system to assess the impact of monocytic factors on neural stem cells, establishing a high-content compatible assay for screening monocyte-induced neural stem cell proliferation and differentiation. The model combined monocytes isolated from healthy donors and human embryonic stem cell derived neural stem cells and integrated both cell-intrinsic and -extrinsic properties. We identified CNS-mimicking culture media options that induced a monocytic phenotype resembling CNS infiltrating monocytes, while allowing adequate monocyte survival. Monocyte-induced proliferation, gliogenic fate and neurogenic fate of neural stem cells were affected by the conditions of monocytic priming and basal neural stem cell culture as extrinsic factors as well as the neural stem cell passage number as an intrinsic neural stem cell property. We developed a high-content compatible human in vitro assay for the integrated analysis of monocyte-derived factors on CNS repair.

Impact of age on tumor characteristics and treatment outcomes in pediatric Differentiated Thyroid Carcinoma.

PURPOSE: There is a tendency to use data generated for adults in the management of pediatric Differentiated Thyroid Carcinoma, neglecting the clinical peculiarities of this condition in childhood. This study aimed to assess and compare the clinical-epidemiological characteristics and their significance in the evolution of thyroid carcinoma diagnosed in childhood across different age groups. METHODS: Seventy-seven patients diagnosed with Differentiated Thyroid Carcinoma (DTC) up to 21 years old were selected and divided into different age groups: up to 10 years, 11 to 18 years, and 19 to 21 years old. Clinical-epidemiological data and their influence in the disease progression were analyzed and compared across age groups. RESULTS: Patients diagnosed below 10 years of age were associated with tumors showing extrathyroidal extension, metastasis in regional lymph nodes, higher levels of stimulated thyroglobulin in the diagnostic iodine-131 whole-body scan (WBS), and under TSH suppression in the last assessment. Additionally, pulmonary metastasis were associated in both diagnostic and post-radioiodine dose WBSs in these younger patients. Analysis of findings in the post-radioiodine therapy WBS revealed significant differences between all age groups (p = 0.0029). The time of diagnosis was identified as a factor associated with an excellent response in subgroups up to 18 years and up to 21 years. No factors associated with dynamic responses over the 1st, 3rd and 5th years of follow-up and the persistence/recurrence of the disease were identified in the subgroup up to 18 years. In the subgroup up to 21 years, having an incomplete structural response in the 3rd year of follow-up increased the chances of recurrent or persistent response by 5.5 times, and by 32.6 times if found in the 5th year of follow-up. CONCLUSIONS: Younger patients exhibited more aggressive tumor characteristics and underwent more rigorous treatment. However, treatment response and disease status in the last assessment, whether free or recurrent/persistence, were similar when comparing the age groups of 11 to 18 and 19 to 21 years. Nonetheless, responses obtained in the 3rd and 5th years post-treatment emerged as factors associated with the persistence/recurrence of the disease in the last assessment in the age group up to 21 years but not in patients diagnosed up to 18 years, a relevant distinction considering the tumor behavior in defining the pediatric age range in thyroid cancer.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties-A multicenter cross-sectional study.

OBJECTIVE: To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. RESULTS: The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. DISCUSSION: CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. CONCLUSION: The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

Abordagem cirúrgica de fratura blow-out através de acesso transconjuntival: relato de caso / Surgical approach to blow-out fracture through transconjunctival access: case report

Introdução: a região orbitária é bastante suscetível a fraturas, devido a sua posição exposta e a ossos frágeis. As fraturas do tipo blow-out caracterizam-se pela fratura do assoalho orbitário com ou sem herniação de conteúdo para o seio maxilar, gerando consequências funcionais e estéticas. Relato do caso: paciente do sexo feminino, 48 anos de idade, vítima de queda da própria altura, compareceu ao Hospital Geral do Estado da Bahia com queixa de diplopia, apresentando fratura de assoalho de órbita direita. Foi programada uma abordagem transconjuntival e instalação de tela de titânio para reconstrução. Na alta hospitalar, a paciente negou diplopia, não apresentando prejuízos funcionais ou estéticos. Conclusão: o acesso transconjuntival possibilita uma adequada exposição do assoalho de órbita, para colocação de telas, deixando uma cicatriz imperceptível na conjuntiva. Apesar das vantagens, este acesso cirúrgico apresenta maior complexidade técnica, sendo pouco realizado pelos cirurgiões

Introduction: the orbital region is very susceptible to fractures due to its exposed position and fragile bones. Blow-out fractures are characterized by fractures of the orbital floor with or without herniation of contents to the maxillary sinus, generating functional and aesthetic consequences. Case report: a 48-year-old female patient, victim of a fall from her height, presented to the General Hospital of the State of Bahia complaining of diplopia, presenting with a fracture of the floor of the right orbit. A transconjunctival approach and installation of titanium mesh for reconstruction were scheduled. At hospital discharge, the patient denied diplopia, with no functional or aesthetic impairments. Conclusion: the transconjunctival approach allows adequate exposure of the orbital floor for mesh placement, leaving an imperceptible scar on the conjunctiva. Despite the advantages, this surgical approach presents greater technical complexity and is rarely performed by surgeons.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties—A multicenter cross-sectional study

Abstract Objective To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. Results The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. Discussion CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. Conclusion The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

Rapid response of a public health reference laboratory to the COVID-19 pandemic.

Introduction. Brazil was one of the most affected countries by the COVID-19 pandemic. Instituto Adolfo Lutz (IAL) is the reference laboratory for COVID-19 in São Paulo, the most populous state in Brazil. In April 2020, a secondary diagnostic pole named IAL-2 was created to enhance IAL's capacity for COVID-19 diagnosis.Hypothesis/Gap Statement. Public health laboratories must be prepared to rapidly respond to emerging epidemics or pandemics.Aim. To describe the design of IAL-2 and correlate the results of RT-qPCR tests for COVID-19 with secondary data on suspected cases of SARS-CoV-2 infection in the São Paulo state.Methodology. This is a retrospective study based on the analysis of secondary data from patients suspected of infection by SARS-CoV-2 whose clinical samples were submitted to real-time PCR after reverse transcription (RT-qPCR) at IAL-2, between 1 April 2020 and 8 March 2022. RT-qPCR Ct results of the different kits used were also analysed.Results. IAL-2 was implemented in April 2020, just over a month after the detection of the first COVID-19 case in Brazil. The laboratory performed 304,250 RT-qPCR tests during the study period, of which 98 319 (32.3 %) were positive, 205827 (67.7 %) negative, and 104 (0.03 %) inconclusive for SARS-CoV-2. RT-qPCR Ct values≤30 for E/N genes of SARS-CoV-2 were presented by 79.7 % of all the samples included in the study.Conclusion. IAL was able to rapidly implement a new laboratory structure to support the processing of an enormous number of samples for diagnosis of COVID-19, outlining strategies to carry out work with quality, using different RT-qPCR protocols.

Manejo das urgências subjetivas nas instituições: que lugar para o serviço-escola? / Maneuvering subjective urgency in institutions: what is the role of psychology school-service? / ¿Manejo de las urgencias subjetivas en las instituiciones: que lugar para el servicio-escuela?

Neste artigo pretende-se discutir a problemática do manejo da urgência subjetiva nas instituições, apoiando-se em uma investigação em andamento no serviço-escola de uma universidade pública. Interroga-se a urgência generalizada, marca de nossos tempos, para situar as coordenadas do manejo da angústia presente nas demandas por assistência em saúde mental dirigidas às instituições. Articula-se, a partir das referências teórico-clínicas dentro da psicanálise de orientação lacaniana, a prática do manejo das urgências em diversos dispositivos de saúde. Pretende-se circunscrever a partir dessa elaboração, o duplo pertencimento dos serviços-escola: lugar de formação e instituição que, de alguma forma, participa da rede de saúde mental. (AU)

This article intends to discuss the problem of maneuvering subjective urgency in institutions, based on ongoing research in development at the school-service of a public university. The widespread urgency is questioned, as a mark of our time, to locate thecoordinates of the management of anxiety present in demands for mental health assistance directed at institutions. It is articulated, through theoretical-clinical references within lacanian oriented psychoanalysis, the practical maneuvering of urgencies in several health devices. It is intended to circumscribe through this elaboration, the double belonging of school-services: place of formation and institution that, in some way, participates in the mental health network. (AU)

En este artículo se pretende discernir la problemática del manejo de la urgencia subjetiva en las instituciones, a partir de una investigación en desarrollo en el servicio-escuela de una universidad pública. Se interroga la urgencia generalizada, marca de nuestra época, para situar las coordinadas del manejo de la angustia presente en las demandas por asistencia en salud mental dirigidas a las instituciones. Desde las referencias teórico-clínicas se articula la práctica del manejo de las urgencias en diversos servicios de salud. Se pretende, a partir de esa discusión, circunscribir la doble pertenencia de los servicios-escuela: lugar de formación que, de alguna forma, participa de la redde salud mental. (AU)

Plasmatic MicroRNAs and Treatment Outcomes of Patients with Metastatic Castration-Resistant Prostate Cancer: A Hospital-Based Cohort Study and In Silico Analysis.

Prostate cancer (PCa) is one of the most common malignancies among men worldwide. Inevitably, all advanced PCa patients develop metastatic castration-resistant prostate cancer (mCRPC), an aggressive phase of the disease. Treating mCRPC is challenging, and prognostic tools are needed for disease management. MicroRNA (miRNA) deregulation has been reported in PCa, constituting potential non-invasive prognostic biomarkers. As such, this study aimed to evaluate the prognostic potential of nine miRNAs in the liquid biopsies (plasma) of mCRPC patients treated with second-generation androgen receptor axis-targeted (ARAT) agents, abiraterone acetate (AbA) and enzalutamide (ENZ). Low expression levels of miR-16-5p and miR-145-5p in mCRPC patients treated with AbA were significantly associated with lower progression-free survival (PFS). The two miRNAs were the only predictors of the risk of disease progression in AbA-stratified analyses. Low miR-20a-5p levels in mCRPC patients with Gleason scores of <8 were associated with worse overall survival (OS). The transcript seems to predict the risk of death regardless of the ARAT agent. According to the in silico analyses, miR-16-5p, miR-145-5p, and miR-20a-5p seem to be implicated in several processes, namely, cell cycle, proliferation, migration, survival, metabolism, and angiogenesis, suggesting an epigenetic mechanism related to treatment outcome. These miRNAs may represent attractive prognostic tools to be used in mCRPC management, as well as a step further in the identification of new potential therapeutic targets, to use in combination with ARAT for an improved treatment outcome. Despite the promising results, real-world validation is necessary.

Current status of musculoskeletal ultrasound in Colombian rheumatology

Introduction: Ultrasound is very useful in the management of rheumatological pathology today. Despite this, in Colombia, progress towards its implementation is limited and entails great difficulties. This deficit is also related to the difficulties in training new human talent. In Colombia, there is no study that identifies the current status of ultrasound among rheumatologists in the country. Methods: This is a descriptive cross-sectional study where medical specialists in Rheumatology practising in Colombia were surveyed through an online form. They were asked about general aspects and for their opinion regarding ultrasound in rheumatology and, if they practiced it, they were asked about specific aspects of its application in clinical practice. Additionally, questions were asked of the rheumatologists who are part of the specialist training processes in the country. Closed multiple-choice or Likert scale assessment questions were presented as required. The main objective was to describe the current use and opinion of musculoskeletal ultrasound in Colombian rheumatologists, as well as the limitations for its implementation. Frequency measurements were performed of the categorical variables of nominal type and ordinal type. The intention was to survey all rheumatologists in the country, who according to Colombian Society of Rheumatology data for the end of 2019 totalled 186. Results: Taking into account the number of rheumatologists of the Colombian Association of Rheumatology (Asoreuma) for 2019 totalling 186, a participation of 139 specialists (74.7%) was obtained, of which 22 of the respondents performed ultrasound in their daily practice (15.8%) the majority in this group being trained in Colombian territory (80.6%). Of the 139 respondents, 64.7% have received some type of training in ultrasound, generally pre-congress courses (22.5%), EULAR courses (16.7%) and training included in their residency curriculum outside the rheumatology service (9.8%). The acceptance of ultrasound is high among rheumatologists practicing in Colombia, 75.5% consider it important or very important and 84.9% indicated that for a comprehensive rheumatology service it is important or very important to have ultrasound. From the responses, however, they consider that its use could change their behaviour frequently, and very frequently in less than half of the cases at 46.7%. Regarding the opinion on the use of ultrasound in specific pathologies, rheumatoid arthritis (77.7%) and crystal arthropathies (72.7%) were considered the highest and most important, as well as in the performance of procedures at 87%. For decision-making in the inflammatory pathology study, 60.4% would consider performing ultrasound compared to 28.8% who responded MRI. Regarding the limitations for implementation, the lack of training in the country (25.6%), followed by the lack of resources to procure equipment (17.9%) and ignorance and lack of interest on the part of the health entities (17.1%) were the most recognized. Conclusion: Musculoskeletal ultrasound is only practiced by a minority of rheumatologists practicing in Colombia, even though the majority consider it important. Its importance lies in its use to treat patients with rheumatoid arthritis, crystal arthropathies and psoriatic arthropathy, as well as for the performance of procedures. More than half of the rheumatologists have received some type of training in ultrasound, usually very few hours' education and without practical or informal training, this being the main problem for its implementation.

Introducción: En la actualidad, la ecografía es de gran utilidad en el manejo de la patología reumatológica. A pesar de esto, en Colombia, los avances para su implementación son escasos y han enfrentado grandes dificultades. Este déficit también se encuentra relacionado con las complicaciones para la formación del nuevo talento humano. En Colombia no se dispone de ningún estudio en el que se identifique el estado actual de la ecografía entre los reumatólogos del país. Métodos: Se trata de un estudio descriptivo de carácter transversal en el cual se encuestó, por medio de un formulario on-line, a médicos especialistas en reumatología que hacen su práctica en el territorio colombiano. Se les preguntó acerca de los aspectos generales y su opinión sobre la ecografía en la reumatología, si la practicaban, como también en torno a los aspectos específicos de su aplicación en la práctica clínica. De manera adicional, se formularon preguntas dirigidas a aquellos reumatólogos que hacen parte de los procesos de capacitación de especialistas en el país; se presentaron preguntas cerradas de opción múltiple o de valoración por escala de Likert según se requirió. El objetivo principal fue describir el uso y la opinión actual sobre la ecografía musculoesquelética en reumatólogos colombianos, así como las limitantes para su implementación. A las variables categóricas de tipo nominal y de tipo ordinal se les hicieron medidas de frecuencia. Se pretendía encuestar a la totalidad de los reumatólogos en el país, los cuales, según información de la Asociación Colombiana de Reumatología (Asoreuma) de finales del 2019, eran 186. Resultados: De acuerdo con el número de reumatólogos proporcionado por la Asoreuma, de 186 especialistas en el año 2019, se obtuvo una participación de 139 de estos (74,7%), de los cuales 22 realizaban ecografía en su práctica diaria (15,8%), siendo este grupo en su mayoría formado en Colombia (80,6%). De los 139 encuestados, el 64,7% había recibido algún tipo de estudios en ecografía, generalmente cursos precongreso (22,5%), cursos de la Liga Europea Contra el Reumatismo (EULAR) (16,7%) y formación incluida en el pensum de su residencia fuera del servicio de reumatología (9,8%). La aceptación de la ecografía es alta entre los reumatólogos que ejercen en Colombia, el 75,5% la consideraron importante o muy importante. Asimismo, el 84,9% indicó que para un servicio de reumatología integral es importante o muy importante contar con ecografía. Sin embargo, los encuestados consideraron que su uso podría llegar a cambiar su conducta de manera frecuente, y muy frecuentemente en menos de la mitad de los casos (46,7%). Con respecto a la opinión sobre el uso de la ecografía en patologías específicas, se consideró con importancia y mucha importancia en artritis reumatoide (77,7%) y artropatías por cristales (72,7%), que fueron las más altas, así como para la realizaron de procedimientos (87%). Para la toma de decisiones en estudio de patología inflamatoria, el 60,4% consideraría realizar ecografía, comparado con 28,8% que se inclina por la resonancia. En relación con las limitaciones para la implementación, la falta de entrenamiento en el país (25,6%), seguida de la carencia de recursos para la consecución del equipo (17,9%) y el desconocimiento y la falta de interés por parte de los entes de salud (17,1%) fueron las más reconocidas. Conclusiones: La ecografía musculoesquelética solamente es practicada por una minoría de los reumatólogos que ejercen en Colombia, a pesar de que la mayoría la considera importante. Su relevancia radica en su uso para tratar a los pacientes con artritis reumatoide, artropatías por cristales y por artropatía psoriásica, así como para la realización de procedimientos. Más de la mitad de los reumatólogos ha recibido algún tipo de formación en ecografía, la mayoría de las veces educación de muy pocas horas o sin entrenamiento práctico, o no formal, lo cual constituye el principal problema para su implementación.

Pre-death grief in patients requiring hematopoietic stem cell transplantation.

This study aimed to understand the pre-death grief experienced by patients requiring Hematopoietic Stem Cell Transplantation. The sample consisted of nine adult patients. A semi-structured interview was applied individually, and audio was recorded and analyzed qualitatively using thematic analysis. The results were organized into two categories, namely: Pre-death grief: Receiving the diagnosis, and Pre-death adjustment: Adaptation to the new condition. It was observed that there was a shock and a need to deal with the losses stemming from a serious illness, but then there was openness to reflection, and from this a new way of being and living emerged.

Aromaterapia na redução dos sintomas de estresse na equipe de enfermagem: revisão integrativa de literatura / Aromaterapia para reducir síntomas de estrés en equipos de enfermería: revisión integradora de la literatura / Aromatherapy in reducing stress symptoms in the nursing team: an integrative literature review

Objetivo: analisar as evidências científicas em relação ao uso da aromaterapia na redução de sintomas relacionados ao estresse na equipe de Enfermagem. Método: revisão integrativa da literatura realizada em 01 de julho de 2022, a partir dos descritores "Aromatherapy", "Stress" e "Nursing", com utilização da plataforma Rayyan para seleção dos estudos realizados por dois pesquisadores independentes. Foram incluídos documentos de acesso digital na íntegra e gratuitos nos idiomas português, inglês ou espanhol, que analisaram a aromaterapia e a população de interesse separadamente. Resultados: doze estudos foram incluídos com predominância de ensaios clínicos randomizados e estudos quase experimentais. Destacou-se aromaterapia inalatória com o óleo essencial de Lavandula angustifolia. A utilização de grupo-controle e múltiplas medições dos desfechos foram os critérios que apresentaram maior fragilidade entre os estudos analisados. Considerações finais: a aromaterapia demonstrou efetividade e segurança na redução de sintomas de estresse para a equipe de Enfermagem.

Objetivo: analizar las evidencias científicas en relación con utilizar Aromaterapia para reducir síntomas relacionados con el estrés en equipos de Enfermería. Método: revisión integradora de la literatura realizada el 1 de julio de 2022 a partir de los siguientes descriptores: "Aromatherapy", "Stress" y "Nursing", y empleando la plataforma Rayyan para seleccionar los estudios a cargo de dos investigadores independientes. Se incluyeron documentos con acceso digital a sus textos completos y gratuitos en portugués, inglés o español, y que analizaran la Aromaterapia y la populación de interés en forma separada. Resultados: se incluyeron doce estudios, con predominio de ensayos clínicos aleatorizados y estudios cuasiexperimentales. Se destacó la Aromaterapia por inhalación con aceite esencial de Lavandula angustifolia. Emplear un Grupo Controle y de múltiples mediciones de los desenlaces fueron los criterios que presentaron mayor fragilidad entre los estudios analizados. Consideraciones finales: la Aromaterapia demostró ser efectiva y segura para reducir síntomas de estrés en equipos de Enfermería.

Objective: to analyze the diverse scientific evidence regarding the use of aromatherapy in reducing stress-related symptoms in the Nursing team. Method: an integrative literature review carried out on July 1st, 2022, based on the "Aromatherapy", "Stress" and "Nursing" descriptors and using the Rayyan platform to select the studies, all in charge of two independent researchers. Full-text and free digital access documents in Portuguese, English or Spanish were included, which analyzed aromatherapy and the population of interest separately. Results: twelve studies were included, with predominance of randomized controlled trials and quasi-experimental studies. Inhalation aromatherapy with Lavandula angustifolia essential oil stood out. The use of a Control Group and multiple outcome measures were the criteria that presented the greatest weakness among the studies analyzed. Final considerations: Aromatherapy showed effectiveness and safety in reducing stress symptoms for the Nursing team.

IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva / IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Sedentary Behaviour Impairs Skeletal Muscle Repair Modulating the Inflammatory Response.

This study investigated whether sedentary behaviour modulates skeletal-muscle repair and tissue inflammatory response after cardiotoxin (CTX)-induced injury. Singly caged rats spent 8 weeks either as a sedentary group (SED, n = 15) or as a control group (EX, n = 15)­caged with running wheels for voluntary running. All rats had each tibial anterior muscle infused either with CTX (CTX; right muscle) or saline solution (Sham; left muscle) and were sacrificed (n = 5 per group) on the 1st, 7th, and 15th day post-injection (dpi). Histological and immunohistochemical analyses were used to calculate myotube percentage and fibrosis accretion, and quantify the number of neutrophils and M1 and M2 macrophage subtypes. The SED group showed an increased number of both neutrophils and M1 macrophages (7th and 15th dpi) compared to the EX group (p < 0.01). The EX group showed an increased number of M2 macrophages on the 1st dpi. On the 7th dpi, the SED group showed a lower myotube percentage compared to the EX group (p < 0.01) and on the 15th dpi showed only 54% of normal undamaged fibres compared to 90% from the EX group (p < 0.01). The SED group showed increased fibrosis on both the 7th and 15th dpi. Our results show that sedentary behaviour affects the inflammatory response, enhancing and prolonging the Th1 phase, and delays and impairs the SMR process.

Modeling human multi-lineage heart field development with pluripotent stem cells.

The cardiomyocyte (CM) subtypes in the mammalian heart derive from distinct lineages known as the first heart field (FHF), the anterior second heart field (aSHF), and the posterior second heart field (pSHF) lineages that are specified during gastrulation. We modeled human heart field development from human pluripotent stem cells (hPSCs) by using single-cell RNA-sequencing to delineate lineage specification and progression. Analyses of hPSC-derived and mouse mesoderm transcriptomes enabled the identification of distinct human FHF, aSHF, and pSHF mesoderm subpopulations. Through staged manipulation of signaling pathways identified from transcriptomics, we generated myocyte populations that display molecular characteristics of key CM subtypes. The developmental trajectory of the human cardiac lineages recapitulated that of the mouse, demonstrating conserved cardiovascular programs. These findings establish a comprehensive landscape of human embryonic cardiogenesis that provides access to a broad spectrum of cardiomyocytes for modeling congenital heart diseases and chamber-specific cardiomyopathies as well as for developing new therapies to treat them.

Seed Phytochemical Profiling of Three Olive Cultivars, Antioxidant Capacity, Enzymatic Inhibition, and Effects on Human Neuroblastoma Cells (SH-SY5Y).

This work evaluated the phytochemical composition of olive seed extracts from different cultivars ('Cobrançosa', 'Galega', and 'Picual') and their antioxidant capacity. In addition, it also appraised their potential antineurodegenerative properties on the basis of their ability to inhibit enzymes associated with neurodegenerative diseases: acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and tyrosinase (TYR). To achieve this goal, the phenolic composition of the extracts was determined through high-performance liquid chromatography coupled with photodiode-array detection and electrospray ionization/ion trap mass spectrometry (HPLC-DAD-ESI/MSn). The antioxidant capacity was assessed by two different methods (ABTS•+ and DPPH•), and the antineurodegenerative potential by the capacity of these extracts to inhibit the aforementioned related enzymes. The results showed that seed extracts presented a high content of phenolic compounds and a remarkable ability to scavenge ABTS•+ and DPPH•. Tyrosol, rutin, luteolin-7-glucoside, nüzhenide, oleuropein, and ligstroside were the main phenolic compounds identified in the extracts. 'Galega' was the most promising cultivar due to its high concentration of phenolic compounds, high antioxidant capacity, and remarkable inhibition of AChE, BChE, and TYR. It can be concluded that olive seed extracts may provide a sustainable source of bioactive compounds for medical and industrial applications.

Antidotal effect of cyclosporine A against α-amanitin toxicity in CD-1 mice, at clinical relevant doses.

Amanita phalloides is one of the most toxic mushrooms worldwide, being responsible for the majority of human fatal cases of mushroom intoxications. α-Amanitin, the most deleterious toxin of A. phalloides, inhibits RNA polymerase II (RNAP II), causing hepatic and renal failure. Herein, we used cyclosporine A after it showed potential to displace RNAP II α-amanitin in silico. That potential was not confirmed either by the incorporation of ethynyl-UTP or by the monitoring of fluorescent RNAP II levels. Nevertheless, concomitant incubation of cyclosporine A with α-amanitin, for a short period, provided significant protection against its toxicity in differentiated HepaRG cells. In mice, the concomitant administration of α-amanitin [0.45 mg/kg intraperitoneal (i.p.)] with cyclosporine A (10 mg/kg i.p. plus 2 × 10 mg/kg cyclosporine A i.p. at 8 and 12 h post α-amanitin) resulted in the full survival of α-amanitin-intoxicated mice, up to 30 days after the toxin's administration. Since α-amanitin is a substrate of the organic-anion-transporting polypeptide 1B3 and cyclosporine A inhibits this transporter and is a potent anti-inflammatory agent, we hypothesize that these mechanisms are responsible for the protection observed. These results indicate a potential antidotal effect of cyclosporine A, and its safety profile advocates for its use at an early stage of α-amanitin intoxications.

Clinical features of hereditary angioedema and warning signs (H4AE) for its identification.

OBJECTIVES: The study describes a case series of hereditary angioedema with C1 Inhibitor Deficiency (C1INH-HAE) in order to corroborate six clinical warning signs "HAAAAE (H4AE)" to enable early identification of this disease. METHODS: The authors analyzed the C1INH-HAE cohort to analyze the clinical aspects of the present study's patients and corroborate the six clinical warning signs of the Hereditary Angioedema Brazilian Guidelines. Data regarding demographics, the onset of disease, time to diagnosis, frequency of attacks per year, organs involved, triggers, crisis duration and their outcomes, and disease treatment were collected. Then the authors developed an acronym, H4AE, to help healthcare professionals remember the warning signs. RESULTS: The authors included 98 patients in the study, with a mean age of 38.1 years, 67.3% being female, and 75.3% with a family history of HAE. HAE diagnosis was delayed, on average, 13.7 years after its initial manifestation. Exploratory laparotomy was reported by 26.9%, and orotracheal intubation by 21.3% of the present study's patients; 61.3% and 30.3% of them were admitted at least once in the hospital and in the intensive care unit, respectively. The authors constructed an acronym "H4AE" with the six warning signs of HAE: Hereditary, recurrent Angioedema, Abdominal pain, Absence of urticaria, Absence of response to antihistamines, Estrogen association. CONCLUSION: C1INH-HAE is still underdiagnosed and associated with high morbidity. The study showed clinical features of this disease, corroborating the warning signs, which may be useful in raising awareness and improving the diagnosis of C1INH-HAE. The authors suggest the acronym "H4AE" to remind the warning signs.