Unveiling the RKIP and EGFR Inverse Relationship in Solid Tumors: A Case Study in Cervical Cancer.

Raf Kinase Inhibitor Protein (RKIP) is recognized as a bona fide tumor suppressor gene, and its diminished expression or loss is associated with the progression and poor prognosis of various solid tumors. It exerts multifaceted roles in carcinogenesis by modulating diverse intracellular signaling pathways, including those governed by HER receptors such as MAPK. Given the significance of HER receptor overexpression in numerous tumor types, we investigated the potential oncogenic relationship between RKIP and HER receptors in solid tumors. Through a comprehensive in silico analysis of 30 TCGA PanCancer Atlas studies encompassing solid tumors (10,719 samples), we uncovered compelling evidence of an inverse correlation between RKIP and EGFR expression in solid tumors observed in 25 out of 30 studies. Conversely, a predominantly positive association was noted for the other HER receptors (ERBB2, ERBB3, and ERBB4). In particular, cervical cancer (CC) emerged as a tumor type exhibiting a robust inverse association between RKIP and EGFR expression, a finding that was further validated in a cohort of 202 patient samples. Subsequent in vitro experiments involving pharmacological and genetic modulation of EGFR and RKIP showed that RKIP depletion led to significant upregulation of EGFR mRNA levels and induction of EGFR phosphorylation. Conversely, EGFR overactivation decreased RKIP expression in CC cell lines. Additionally, we identified a common molecular signature among patients depicting low RKIP and high EGFR expression and demonstrated the prognostic value of this inverse correlation in CC patients. In conclusion, our findings reveal an inverse association between RKIP and EGFR expression across various solid tumors, shedding new light on the underlying molecular mechanisms contributing to the aggressive phenotype associated with RKIP and EGFR in cervical cancer.

Relationship Between Lipodystrophy, Body Composition, Metabolic Profile, and Serum Levels of Adipocytokines.

Background: Despite the benefits in improving the clinical state of people living with HIV/aids (PLWHA), some side effects associated with the use of antiretroviral therapy (ART) are reported. Redistribution of body fat has been associated with treatment and is characterized by morphological changes, also known as lipodystrophy. The complications of metabolic and morphological changes in these individuals seem to increase the risk of cardiovascular disease. Adipocytokines are proteins that have essential functions in biological processes, in which the levels of these proteins are related to the pathogenesis of metabolic syndrome (MS) and cardiovascular disease. Recent studies have shown that such levels are generally modified in PLWHA, regardless of whether the treatment is established or not. An application of methods for body fat estimation in patients with fat redistribution, as in the case of aids, especially those that quantify body fat by segments, appears to clarify these alterations and plays an important role in the development of multiprofessional treatment. Objectives: This investigation was carried out to compare and correlate body composition, biochemical metabolic parameters, and levels of adipocytokines and cytokines of PLWHA, with and without lipodystrophy, with individuals with negative HIV serology and stratified by sex. Material and Methods: This is a cross-sectional study in which body composition, metabolic and anthropometric changes, and levels of adipocytokines of 110 individuals were assessed. These individuals were paired in sex, age, and body mass index (BMI) and subdivided into three groups: PLWHA with and without a clinical diagnosis of lipodystrophy associated with HIV, and a group control. Results: Collinearity was identified both in the general sample and for genders of the waist-to-height ratio (WHtR) with all anthropometric parameters, except for muscle mass. The results show strong association between IFN-γ and TNF-α both in the general sample and for genders and moderate correlation between leptin and fasting glucose for women; worsening of the triglyceride profile in both women with lipodystrophy compared with the control group and men without lipodystrophy compared with the control group; higher serum TNF-α values among men without lipodystrophy compared to those with HIV-associated lipodystrophy (HALS). Conclusions: The results of this study underline that, considering the manifestations of the syndrome, these patients have a high-risk endocrine metabolic profile for cardiovascular events.

Association between a soy-based infant diet and the onset of puberty: A systematic review and meta-analysis.

The objective of this systematic review was to evaluate the association between a soy-based infant diet and the onset of puberty. We included studies in which children were fed a soy-based diet, and we compared them with those who were not. The primary outcomes were the onset of puberty in girls (thelarche, pubarche, and menarche age), boys (pubarche, voice change, testicular and penis enlargement age), and both (risk of delayed and precocious puberty [PP]). Search strategies were performed in PubMed, Embase, LILACS, and CENTRAL databases. Two reviewers selected eligible studies, assessed the risk of bias, and extracted data from the included studies. The odds ratio (OR) and mean difference (MD) were calculated with a 95% confidence interval (CI) as a measure of the association between soy consumption and outcomes. We used a random-effects model to pool results across studies and the Grading of Recommendations Assessment, Development, and Evaluation to evaluate the certainty of evidence. We included eight studies in which 598 children consumed a soy-based diet but 2957 did not. The primary outcomes that could be plotted in the meta-analysis were the risk of PP and age at menarche. There was no statistical difference between groups for PP (OR: 0.51, 95% CI: 0.09 to 2.94, 3 studies, 206 participants, low certainty of evidence). No between-group difference was observed in menarche age (MD 0.14 years, 95% CI -0.16 to 0.45, 3 studies, 605 children, low certainty of evidence). One study presented this outcome in terms of median and interquartile range, and although the onset of menarche was marginally increased in girls who received a soy-based diet, the reported age was within the normal age range for menarche. We did not find any association between a soy-based infant diet and the onset of puberty in boys or girls. Trial Registration: PROSPERO registration: CRD42018088902.

Impact of environmental changes on Dermatology.

Urbanization, pollution and the modification of natural landscapes are characteristics of modern society, where the change in human relations with the environment and the impact on biodiversity are environmental determinants that affect the health-disease relationship. The skin is an organ that has a strong interface with the environment and, therefore, the prevalence patterns of dermatoses may reflect these environmental changes. In this article, aspects related to deforestation, fires, urbanization, large-scale agriculture, extensive livestock farming, pollution and climatic changes are discussed regarding their influence on the epidemiology of skin diseases. It is important that dermatologists be aware of their social responsibility in order to promote sustainable practices in their community, in addition to identifying the impacts of environmental imbalances on different dermatoses, which is essential for the prevention and treatment of these diseases.

Acute bullous hemorrhagic prurigo: a diagnostic challenge

Abstract Insect bites and bite wounds are quite common and most often have mild repercussions in humans. Statistics on the incidence of accidents caused by insects are not available, and the skin reactions after the bites are not always known. The authors present two cases of patients with hemorrhagic blisters on their hands after tabanidae bites and discuss the factors that cause the problem and the importance of the differential diagnosis of blisters with hemorrhagic content on human skin.

Acute bullous hemorrhagic prurigo: a diagnostic challenge.

Insect bites and bite wounds are quite common and most often have mild repercussions in humans. Statistics on the incidence of accidents caused by insects are not available, and the skin reactions after the bites are not always known. The authors present two cases of patients with hemorrhagic blisters on their hands after tabanidae bites and discuss the factors that cause the problem and the importance of the differential diagnosis of blisters with hemorrhagic content on human skin.

Segurança do paciente em centro cirúrgico: percepção dos profissionais de enfermagem / Patient safety in the surgical center: nursing professionals perceptions / Seguridad del paciente en centro quirúrgico: percepción de los profesionales de enfermería

Objetivo: Conhecer as ações realizadas pelos profissionais de enfermagem direcionadas à segurança do paciente no ambiente de centro cirúrgico (CC), segundo discurso desses profissionais. Método: Trata-se de uma pesquisa de campo, de caráter exploratório e descritivo, com abordagem qualitativa. Os dados foram coletados em um CC por meio de entrevista gravada norteada por roteiro estruturado com quatro questões abertas fundamentadas no método do discurso do sujeito coletivo (DSC), com foco na prática da assistência segura para o paciente no CC. A amostra foi composta de 12 profissionais de enfermagem, sendo um auxiliar e 11 técnicos. Os dados foram organizados e analisados segundo método do DSC. Resultados: As respostas deram origem a seis discursos, que revelaram preocupação em manter a segurança do paciente por meio de identificação, comunicação entre equipe multiprofissional e paciente, prevenção de quedas, ações para a prática segura, comunicação intersetorial e manutenção de equipamentos. Conclusão: Os profissionais de enfermagem compreendem a importância da segurança do paciente no CC e consideram que o conjunto de práticas realizadas deve estar alinhado, de modo que minimize eventos adversos e proporcione assistência qualificada, em benefício da qualidade de vida do paciente.

Objective: To know the actions aimed at patient safety performed by nursing professionals in Surgical Centers (SC), and in accordance with these professionals' perceptions. Method: This is an exploratory and descriptive field research with a qualitative approach. Data were collected in a SC through a recorded interview guided by a structured script with four open questions based on the Discourse of the Collective Subject (DCS) method, focusing on patient safe care practices in the SC. The sample was constituted by 12 nursing professionals, one of which was an auxiliary and 11 were technicians. Data were organized and analyzed according to the DCS method. Results: The answers resulted in six discourses that revealed concern with patient safety regarding identification, communication between multiprofessional team and patient, fall prevention, safe practices, intersectoral communication, and equipment maintenance. Conclusion: Nursing professionals understand the importance of patient safety in the SC, and consider that the set of practices performed should be aligned in a way that will minimize adverse events and provide qualified assistance in the benefit of the patient's quality of life.

Objetivo: Conocer las acciones tomadas por los profesionales de enfermería para la seguridad del paciente en el entorno del Centro Quirúrgico (CQ), según el discurso de estos profesionales. Método: Esta es una investigación de campo exploratoria y descriptiva, con un enfoque cualitativo. Los datos se recopilaron en un CQ a través de una entrevista grabada guiada por un guión estructurado con cuatro preguntas abiertas basadas en el método del Discurso del Sujeto Colectivo (CSD), con un enfoque en la práctica de la atención segura de los pacientes en el CQ. La muestra estuvo compuesta por 12 profesionales de enfermería, un asistente y 11 técnicos. Los datos fueron organizados y analizados de acuerdo con el método DSC. Resultados: Las respuestas dieron lugar a seis discursos, que revelaron preocupación por mantener la seguridad del paciente a través de la identificación, la comunicación entre el equipo multidisciplinario y el paciente, la prevención de caídas, las acciones para la práctica segura, la comunicación intersectorial y el mantenimiento del equipo. Conclusión: Los profesionales de enfermería entienden la importancia de la seguridad del paciente en el CQ y consideran que el conjunto de prácticas realizadas debe estar alineado, para minimizar los eventos adversos y proporcionar asistencia calificada, en beneficio de la calidad de vida del paciente.

Riscos ocupacionais e os resíduos de serviços de saúde em centro cirúrgico / Occupational risks and health care waste in the surgery center / Riesgos ocupacionales y residuos de salud en un centro quirúrgico

Objetivo: Conhecer a relação dos riscos ocupacionais com os resíduos de serviços de saúde (RSS), na perspectiva de profissionais de enfermagem que atuam no centro cirúrgico (CC). Método: Trata-se de uma pesquisa de campo de caráter exploratório e descritivo e abordagem qualitativa. Os dados foram coletados por meio de entrevista gravada, com três questões abertas sobre a geração e o manejo de resíduos e riscos à saúde dos profissionais de enfermagem. A amostra foi composta de 11 técnicos e dois auxiliares de enfermagem. Os dados foram organizados e analisados segundo a proposta do método do discurso do sujeito coletivo (DSC). Resultados: Os discursos revelaram preocupação em realizar o manejo adequado dos resíduos gerados, com destaque para os biológicos e perfurocortantes. Os profissionais compreendem que o não cumprimento de práticas seguras de manejo pode expor prejuízos à própria saúde, à do paciente e à de outros profissionais. Conclusão: Os resultados evidenciaram exposição dos profissionais de enfermagem aos resíduos gerados no CC, o que reforça a necessidade de práticas contínuas de orientações e treinamentos para o manejo apropriado desses resíduos, com a finalidade de minimizar riscos de exposição dos profissionais, dos pacientes e do ambiente.

Objective: To understand the relationship between occupational risks and health care waste (HCW), from the perspective of nursing professionals working in the surgery center (SC). Method: This is exploratory and descriptive field research with a qualitative approach. Data were collected through recorded interviews, with three open questions on the generation and management of waste and health risks to nursing professionals. The sample consisted of 11 technicians and two auxiliary nurses. Data were organized and analyzed according to the collective subject discourse (CSD) method. Results: The speeches revealed concern in adequately managing the generated waste, particularly biological and sharp ones. Professionals understand that failure to comply with safe management practices can lead to damage to their health, that of the patient, and that of other professionals. Conclusion: The results showed the exposure of nursing professionals to the waste generated in the SC, which reinforces the need for ongoing guidance practices and training for the appropriate management of these residues, in order to minimize risks of exposure for professionals, patients, and the environment.

Objetivo: Conocer la relación entre riesgos laborales y los residuoe de los servicios de salud (RSS), desde la perspectiva de los profesionales de enfermería que trabajan en quirófano (CQ). Método: Esta es una investigación de campo exploratoria y descriptiva con un enfoque cualitativo. Los datos se recopilaron mediante entrevistas grabadas, con tres preguntas abiertas sobre la generación y gestión de residuos y riesgos para la salud de los profesionales de enfermería. La muestra consistió en 11 técnicos y dos auxiliares de enfermería. Los datos fueron organizados y analizados de acuerdo con el método del discurso del sujeto colectivo (DSC). Resultados: Los discursos revelaron una preocupación por llevar a cabo el manejo adecuado de los desechos generados, con énfasis en productos biológicos y objetos punzantes. Los profesionales entienden que el incumplimiento de las prácticas de gestión segura puede exponer el daño a su propia salud, la del paciente y la de otros profesionales. Conclusión: Los resultados evidenciaron la exposición de los profesionales de enfermería a los desechos generados en el CQ, lo que refuerza la necesidad de orientación continua y prácticas de capacitación para el manejo adecuado de estos desechos, a fin de minimizar los riesgos de exposición de profesionales, pacientes y medio ambiente

Effectiveness of non-pharmacological strategies in the management of type 2 diabetes in primary care: a protocol for a systematic review and network meta-analysis.

INTRODUCTION: Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but various of them have never been compared directly to determine the best strategies. OBJECTIVE: This study will evaluate the comparative effects of non-pharmacological strategies in the management of T2DM in primary care or community settings. METHODS AND ANALYSIS: We will perform a systematic review and network meta-analysis (NMA), and will include randomised controlled trials if one of the following interventions were applied in adult patients with T2DM: nutritional therapy, physical activity, psychological interventions, social interventions, multidisciplinary lifestyle interventions, diabetes self-management education and support (DSMES), technology-enabled DSMES, interventions delivered only either by pharmacists or by nurses, self-blood glucose monitoring in non-insulin-treated T2DM, health coaching, benchmarking and usual care. The primary outcome will be glycaemic control (glycated haemoglobin (HbA1c) (%)), and the secondary outcomes will be weight loss, quality of life, patient satisfaction, frequency of cardiovascular events and deaths, number of patients in each group with HbA1c <7, adverse events and medication adherence. We have developed search strategies for Embase, Medline, Latin American and Caribbean Health Sciences Literature, Cochrane Central Register of Controlled Trials, Trip database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature Australasian Medical Index and Chinese Biomedical Literature Database. Four reviewers will assess the studies for their eligibility and their risk of bias in pairs and independently. An NMA will be performed using a Bayesian hierarchical model, and the treatment hierarchy will be obtained using the surface under the cumulative ranking curve. To determine our confidence in an overall treatment ranking from the NMA, we will follow the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: As no primary data collection will be undertaken, no formal ethical assessment is required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and the popular press. PROSPERO REGISTRATION NUMBER: CRD42019127856.

Multiscale Hill-type modeling of the mechanical muscle behavior driven by the neural drive in isometric conditions.

In this study, we present a new model describing the mechanical behavior of the skeletal muscle during isometric contraction. This model is based on a former Hill-inspired model detailing the electromechanical behavior of the muscle based on the Huxley formulation. However, in this new multiscale model the muscle is represented at the Motor Unit (MU) scale. The proposed model is driven by a physiological input describing the firing moments of the activated MUs. Definition of both voluntary and evoked MU recruitment schemes are described, enabling the study of both contractions in isometric conditions. During this type of contraction, there is no movement of the joints and the tendon-muscle complex remains at the same length. Moreover, some well-established macroscopic relationships such as force-length or force-velocity properties are considered. A comparison with a twitch model using the same input definition is provided with both recruitment schemes exhibiting limitations of twitch type models. Finally, the proposed model is validated with a comparison between simulated and recorded force profiles following eight electrical stimulations pulses in isometric conditions. The simulated muscle force was generated to mimic the one recorded from the quadriceps of a patient implanted with a functional electrical stimulation neuroprosthesis. This validation demonstrates the ability of the proposed model to reproduce realistically the skeletal muscle contractions and to take into account subject-specific parameters.

Effectiveness of strategies for nutritional therapy for patients with type 2 diabetes and/or hypertension in primary care: protocol of a systematic review of randomised controlled trials.

INTRODUCTION: Despite the increasing number of drugs available and various guidelines on the management of type 2 diabetes mellitus (T2DM) and hypertension, an expressive number of patients continue with these diseases uncontrolled. Nutrition therapy (NT) plays a fundamental role in the prevention and management of these comorbidities, as well as in the prevention of complications related to them. The objective of this review is to evaluate the effectiveness of NT strategies in the management of patients with T2DM and/or hypertension in primary care. The selected strategies did not substitute pharmaceutical treatment but instead focused on preventing a sedentary lifestyle and stimulating healthy nutrition. METHODS AND ANALYSIS: We will perform a systematic review according to Cochrane methodology of randomised controlled trials, wherein patients with T2DM and/or hypertension were allocated into one of the two groups: NT strategy, which may be of dietary quality or energy restriction, and conventional treatment. The primary outcomes will be glycaemic and blood pressure (BP) control, measured by final glycosylated hemoglobin (HbA1c) (%) and BP (mm Hg), respectively. Four general and adaptive search strategies have been created for the Embase, Medline, Latin American and Caribbean Health Sciences Literature (LILACS) and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. Two reviewers will independently select eligible studies, assess the risk of bias and extract data from the included studies. Similar outcomes measured in at least two trials will be plotted in the meta-analysis using Review Manager V.5.3. The quality of evidence of the effect estimate of the intervention will be generated according to the Grading of Recommendations Assessment, Development, and Evaluation Working Group. ETHICS AND DISSEMINATION: As no primary data collection will be undertaken, formal ethical assessment is not required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and the popular press. PROSPERO REGISTRATION NUMBER: Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 20 December 2018 (Registration number CRD42018118117).

Interferência de fatores ambientais no sono e repouso dos recém-nascidos de alto risco / Interference of environmental factors in the sleep and rest of high-risk newborns

O objetivo dessa pesquisa foi conhecer as experiências vivenciadas pelos profissionais de enfermagem sobre os fatores ambientais que interferem no sono e repouso do recém-nascido de alto risco em Unidade de Terapia Intensiva Neonatal. Pesquisa de campo, com abordagem qualitativa, foi realizada em um hospital privado no interior de São Paulo. Os dados foram coletados a partir de três questões norteadoras por meio de uma única entrevista gravada com 18 profissionais de enfermagem (13 técnicos de enfermagem e cinco enfermeiros). As respostas foram agrupadas e extraídas as respectivas expressões-chave e ideias centrais de acordo com a proposta do método do Discurso do Sujeito Coletivo e a partir dessas informações foram construídos os DSC que revelaram a preocupação dos participantes sobre a necessidade de minimizar as possíveis exposições desnecessárias a iluminação, ruído e manipulações excessivas como forma de contribuir para a recuperação do recém-nascido de alto risco.

The objective of this research was to learn about the experiences lived by nursing professionals related to the environmental factors that interfere with the sleep and rest of high-risk newborns in a neonatal intensive care unit. Field research was performed using a qualitative approach in a private hospital in the rural area of São Paulo. Data was collected from a recorded interview with 18 nursing professionals (13 nursing technicians and 5 nurses) that used three guiding questions. The responses were grouped, and the following key expressions and central ideas were extracted according to the proposed method of the Collective Subject Discourse, and this information originated the discourses that revealed the participants' concern about the need to minimize possible unnecessary exposure to lighting, noise and excessive handling as a way to contribute to the recovery of high-risk newborns.

Promoção da motricidade e saúde mental dos idosos: um estudo de revisão / Promotion the motricity and mental health in the elderly: a review of the literature

O objetivo deste artigo é analisar e sintetizar as informações disponibilizadas pelos estudos relevantes publicados sobre as principais práticas que estimulam a motricidade e a saúde mental dos idosos. Trata-se de uma revisão de literatura realizada com artigos indexados nas bases de dados Lilacs, Scielo, PubMed, Web of Science e Science Direct. São muitos os benefícios das atividades físicas para manutenção da mobilidade, motricidade e saúde mental dos idosos, podendo ser consideradas estratégias importantes para a promoção da saúde. Dentre as principais atividades, destacam-se na literatura o treinamento funcional, os exercícios aquáticos, a dança, as atividades nas academias da terceira idade, os exercícios físicos resistidos, a caminhada e a yoga. Nesse sentido, faz-se necessária a criação de mais espaços e maior acessibilidade aos idosos para as práticas que promovam a saúde no contexto da interdisciplinaridade, estimulando e preservando a capacidade funcional e cognitiva dessa população.

This study aims to analyze and summarize the information available on relevant studies published about main practices that stimulate the kinetics and mental health of elderly. This is a literature review carried out with papers indexed in the databases Lilacs, Scielo, PubMed, Web of Science and Science Direct. The studies indicated that there are many benefits of physical activities to maintain the mobility, kinetics and mental health of the elderly, and they can be considered important strategies for health promotion. The main activities include functional training, water exercises, dance, elderly gym, resistive physical exercises, walking, and yoga. Thus, it is necessary to create more spaces and accessibility for elderly for practices that promote health of this population in the context of inter-disciplinarity, stimulating and preserving the functional and cognitive capacities.

Diabetes mellitus and the skin.

Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.