Subacute exposure to a mixture of tributyltin plus mercury impairs reproductive axis function, exacerbating premature ovarian insufficiency features and reducing fertility in female rats.

Tributyltin (TBT) and mercury (Hg) are endocrine-disrupting chemicals that individually cause reproductive complications. However, the reproductive consequences of exposure to a mixture of TBT plus Hg are not well known. We hypothesized that exposure to a mixture of TBT plus Hg would alter hypothalamic-pituitary-gonadal (HPG) axis function. Female rats were exposed to this mixture daily for 15 days, after which chemical accumulation in the tissues, morphology, hormone levels, inflammation, fibrosis, and protein expression in the reproductive organs were assessed. Increases in tin (Sn) and Hg levels were detected in the serum, HPG axis, and uterus of TBT-Hg rats. TBT-Hg rats exhibited irregular estrous cycles. TBT-Hg rats showed an increase in gonadotropin-releasing hormone (GnRH) protein expression and follicle-stimulating hormone (FSH) levels and a reduction in luteinizing hormone (LH) levels. Reduced ovarian reserve, antral follicles, corpora lutea (CL) number, and estrogen levels and increased atretic and cystic follicles were found, suggesting that TBT-Hg exposure exacerbated premature ovarian insufficiency (POI) features. Furthermore, TBT-Hg rats exhibited increased ovarian mast cell numbers, expression of the inflammatory markers IL-6 and collagen deposition. Apoptosis and reduced gland number were observed in the uteri of TBT-Hg rats. A reduction in the number of pups/litter for 90 days was found in TBT-Hg rats, suggesting impaired fertility. Strong negative correlations were found between serum and ovarian Sn levels and ovarian Hg levels and ovarian reserve and CL number. Collectively, these data suggest that TBT plus Hg exposure leads to abnormalities in the HPG axis, exacerbating POI features and reducing fertility in female rats.

Bons encontros e Cidadania: os Sentidos Atribuídos ao Serviço de Convivência e Fortalecimento de Vínculos pelos(as) Idosos(as) / Good meetings and Citizenship: the meanings attributed to the Service of Coexistence and Strengthening of Bonds (Serviço de Convivência e Fortalecimento de Vínculos) by Older Adults / Buenos Encuentros y Ciudadanía: los Significados Atribuidos al Servicio de Convivencia y Fortalecimiento de Lazos por los Adultos Mayores

Resumo: Este artigo tem como objetivo analisar os dados produzidos por uma pesquisa qualitativa que investigou os sentidos atribuídos ao Serviço de Convivência e Fortalecimento de Vínculos (SCFV) por seus usuários(as) em Florianópolis/SC. Por meio da observação participante realizada em um SCFV durante três meses e da aplicação de uma entrevista coletiva com idosos(as), este artigo traz algumas análises sobre os processos de significação vivenciados por esses sujeitos. Apoiados na perspectiva sócio-histórica, elaboramos dois eixos de significação, que serão discutidos neste artigo: 1) Intersubjetividade e vínculo: o SCFV como "lugar acolhedor" e de "bons encontros"; 2) O(a) idoso(a) e os processos de exclusão: o SCFV como promotor da cidadania. Em termos de resultados, é possível afirmar que esse espaço se configura como um lugar importante na vida desses(as) idosos(as) - onde eles(as) se sentem acolhidos, ouvidos e reconhecidos como sujeitos. Além do fato de esse espaço ser marcado por afetos e "bons encontros", o grupo também o revelou como um lugar potente para processos de reflexão e questionamento contra as diversas formas de segregação e violências vividas cotidianamente por ele.

Abstract: This study aims to analyze the data produced by qualitative research that investigated the meanings attributed to the Service of Coexistence and Strengthening of Bonds (Serviço de Convivência e Fortalecimento de Vínculos - SCFV) by its users in the municipality of Florianópolis. By participant observation carried out in an SCFV for three months and the application of a collective interview with older adults, this study will bring some analysis of the processes of meaning experienced by these subjects. Sustained by the socio-historical perspective, we elaborated two axes of meaning to be discussed in this study : 1. Intersubjectivity and bonding: the SCFV as a "warm place" and "good meetings;" and 2. Older adults and processes of exclusion: the SCFV as a enhancer of citizenship. Results show that this space configures an important place in the lives of these older adults — a place in which they feel welcomed, heard, and recognized as subjects. In addition to the fact this space is marked by affections and "good meetings," the group also shows itself as a potent place for processes of reflection and questioning against the various forms of segregation and violence daily experienced by these people.

Resumen: Este artículo tiene como objetivo analizar los datos producidos por un estudio cualitativo sobre los significados atribuidos al Servicio de Convivencia y Fortalecimiento de Lazos (SCFL) por sus usuarios en Florianópolis (Santa Catarina, Brasil). Desde la observación participante realizada en un SCFL durante el período de tres meses y desde la aplicación de una entrevista colectiva con personas mayores, este artículo presenta algunos análisis sobre los procesos de significado vividos por estos sujetos. Apoyados en la perspectiva sociohistórica, elaboramos dos ejes de significado que serán discutidos: 1) Intersubjetividad y vinculación: el SCFL como "lugar de acogida" y "buenos encuentros"; 2) Las personas mayores y los procesos de exclusión: el SCFV como promotor de ciudadanía. Los resultados permiten afirmar que este espacio se configura como un lugar importante en la vida de estas personas mayores, un lugar donde se sienten acogidos, escuchados y reconocidos como sujetos. Además de que este espacio está marcado por afectos y "buenos encuentros", el grupo también se reveló como un lugar propenso a procesos de reflexión y cuestionamiento frente a las diversas formas de segregación y violencia que viven a diario estas personas.

Prevalence, risk indicators, and clinical characteristics of peri-implant mucositis and peri-implantitis for an internal conical connection implant system: A multicenter cross-sectional study.

BACKGROUND: Peri-implant disease prevalence is associated with a multifactorial etiology and distinct clinical characteristics of inflammation. METHODS: The present study aimed to assess the prevalence of peri-implant diseases, identify related risk indicators, and associate specific clinical characteristics to peri-implant biological complications in the medium term. Peri-implant diseases were classified according to established case criteria. Patients' data, implant and/or prosthetic features, and maintenance records were collected. Clinical characteristics such as bleeding on probing (BOP), suppuration (SUPP), keratinized mucosa (KM), probing depth (PD), marginal recession (MR), and modified plaque index (mPI) were recorded. RESULTS: Ninety-nine patients with 266 implants with a mean functional duration of 30.26 months were evaluated. Peri-implant mucositis and peri-implantitis prevalence totaled to 49.5% and 15.15% (patient level), respectively. Peri-implant mucositis was associated with osteoporosis (odds ratio [OR] 6.09), age (OR 0.97), diabetes mellitus (OR 3.09), cemented-retained prosthesis (OR 3.81), and partial prosthesis (OR 2.21). Peri-implantitis was associated with osteoporosis (OR 7.74) and periodontitis (OR 2.74), cemented prosthesis (OR 10.12), partial and full arch prostheses (OR 12.35 and 19.86), implant diameter (OR 3.64), abutment transmucosal height (OR 3.39), and hygiene difficulty (OR 3.14). Furthermore, mPI score 3 (OR 3.27) and PD scores (OR 1.64) were associated with peri-implant mucositis, while mPI score 3 (OR 16.42), KM (OR 1.53), PD (OR 1.81), MR (OR 2.61), and the relationship between KM and PD (OR 0.63) were associated with peri-implantitis. CONCLUSION: In the medium term, peri-implant diseases were correlated with factors inherent to the patient's conditions, presurgical treatment plan, and hygiene maintenance care. The knowledge of the mentioned factors and featured clinical characteristics can be crucial for disease prevention and establishment of a superior implant therapy prognosis.

Therapeutic potential of extracellular vesicles derived from cardiac progenitor cells in rodent models of chemotherapy-induced cardiomyopathy.

Background: Current treatments of chemotherapy-induced cardiomyopathy (CCM) are of limited efficacy. We assessed whether repeated intravenous injections of human extracellular vesicles from cardiac progenitor cells (EV-CPC) could represent a new therapeutic option and whether EV manufacturing according to a Good Manufacturing Practices (GMP)-compatible process did not impair their bioactivity. Methods: Immuno-competent mice received intra-peritoneal injections (IP) of doxorubicin (DOX) (4 mg/kg each; cumulative dose: 12 mg/kg) and were then intravenously (IV) injected three times with EV-CPC (total dose: 30 billion). Cardiac function was assessed 9-11 weeks later by cardiac magnetic resonance imaging (CMR) using strain as the primary end point. Then, immuno-competent rats received 5 IP injections of DOX (3 mg/kg each; cumulative dose 15 mg/kg) followed by 3 equal IV injections of GMP-EV (total dose: 100 billion). Cardiac function was assessed by two dimensional-echocardiography. Results: In the chronic mouse model of CCM, DOX + placebo-injected hearts incurred a significant decline in basal (global, epi- and endocardial) circumferential strain compared with sham DOX-untreated mice (p = 0.043, p = 0.042, p = 0.048 respectively) while EV-CPC preserved these indices. Global longitudinal strain followed a similar pattern. In the rat model, IV injections of GMP-EV also preserved left ventricular end-systolic and end-diastolic volumes compared with untreated controls. Conclusions: Intravenously-injected extracellular vesicles derived from CPC have cardio-protective effects which may make them an attractive user-friendly option for the treatment of CCM.

Quality improvement in the implementation science paradigm in professional programs: scoping review / Mejora de la calidad en el paradigma de la ciencia de la implementación en programas profesionales: revisión del alcance / Melhoria de qualidade no paradigma da ciência da implementação em programas profissionais: revisão de escopo

ABSTRACT Objective: To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs. Method: This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol. Results: 18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs. Conclusion: Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

RESUMEN Objetivo: Mapear el conocimiento sobre Mejora de la Calidad en el paradigma de la ciencia de la implementación, en la formación de posgrado en enfermería en programas profesionales. Método: Se trata de una revisión de alcance, realizada de octubre a diciembre de 2021, siguiendo los supuestos establecidos por el Instituto Joanna Briggs y el protocolo PRISMA-ScR. Resultados: Se seleccionaron 18 estudios. Siendo, 7 artículos (38,8%) sobre las estrategias de implementación y desarrollo de proyectos de Mejora de la Calidad para estudiantes de posgrado en enfermería. Los estudios incluidos enfatizan la Mejora de la Calidad como una estrategia metodológica capaz de capturar un problema en la práctica, para ser resuelto sin perder el rigor científico, y resaltan la importancia de obtener habilidades de Mejora de la Calidad en los programas profesionales. Conclusión: La ciencia de la implementación y los proyectos de mejora de la calidad avanzan en los programas profesionales para mejorar y desarrollar una atención médica de calidad.

RESUMO Objetivo: Mapear o conhecimento referente a Melhoria de Qualidade no paradigma da ciência da implementação na educação de pós-graduação em enfermagem de programas profissionais. Método: Trata-se de revisão de escopo, realizada de outubro a dezembro de 2021, seguindo os pressupostos estabelecidos pelo Joanna Briggs Institute e pelo protocolo PRISMA-ScR. Resultados: Foram selecionados 18 estudos. Sendo, 7 artigos (38,8 %) sobre as estratégias de implementação e de desenvolvimento de projetos de Melhoria de Qualidade para estudantes de pós-graduação em enfermagem.Os estudos incluídos fazem ênfase à Melhoria de Qualidade como estratégia metodológica capaz de captar uma problemática da prática, a ser resolvida sem perder o rigor científico e destaca a importância de obter habilidades de Melhoria de Qualidade nos programas profissionais. Conclusão: A ciência da implementação e os projetos de Melhoria da Qualidade avançam nos programas profissionais, para aprimorar e desenvolver os cuidados de saúde com qualidade.

Os quilombos e suas interfaces com o Sistema Único de Assistência Social / Quilombos and their interfaces with the Unified Social Assistance System

O artigo apresenta a discussão sobre os quilombos no estado do Rio Grande do Sul (RS) e as aproximações com as ofertas inscritas no Sistema Único de Assistência Social (SUAS), com objetivo de analisar as particularidades da questão étnico-racial acerca dos povos quilombolas no estado do Rio Grande do Sul, para a afirmação desta pauta na agenda do SUAS. Socializa os resultados de uma pesquisa documental de abordagem mista com ênfase qualitativa. Revela a potência e a complementaridade das informações encontradas nos instrumentos do SUAS, como nos dados do Censo SUAS (2019) do Centro de Referência de Assistência Social (CRAS) e do Centro de Referência Especializado de Assistência Social (CREAS) e os dados do Cadastro Único (2021), frente ao reconhecimento dos territórios quilombolas, embora ainda seja necessário ampliar as ações de educação permanente acerca do debate sobre a questão étnico-racial e os quilombos na agenda da política de assistência social

The article presents the discussion about the quilombos in the state of Rio Grande do Sul (RS) and the approximations with the offers registered in the Unified Social Assistance System (SUAS), with the objective of analyzing the particularities of the ethnic-racial issue concerning the quilombola peoples in the state of Rio Grande do Sul, for the affirmation of this agenda in the SUAS agenda. It socializes the results of a mixed approach documentary research with a qualitative emphasis. It reveals the power and complementarity of the information found in the SUAS instruments, as in the data from the SUAS Census (2019) from the Social Assistance Reference Center (CRAS) and the Specialized Reference Center for Social Assistance (CREAS) and data from the Single Registry (2021), in view of the recognition of quilombola territories, although it is still necessary to expand permanent education actions regarding the debate on the ethnic-racial issue and the quilombos in the social assistance policy agenda

Biomaterial-embedded extracellular vesicles improve recovery of the dysfunctional myocardium.

Extracellular vesicles (EV) are increasingly recognized as a therapeutic option in heart failure. They are usually administered by direct intramyocardial injections with the caveat of a rapid wash-out from the myocardium which might weaken their therapeutic efficacy. To improve their delivery in the failing myocardium, we designed a system consisting of loading EV into a clinical-grade hyaluronic acid (HA) biomaterial. EV were isolated from umbilical cord-derived mesenchymal stromal cells. The suitability of HA as a delivery platform was then assessed in vitro. Rheology studies demonstrated the viscoelastic and shear thinning behaviors of the selected HA allowing its easy injection. Moreover, the release of HA-embedded EV was sustained over more than 10 days, and EV bioactivity was not altered by the biomaterial. In a rat model of myocardial ischemia reperfusion, we showed that HA-embedded EV preserved cardiac function (echocardiography), improved angiogenesis and decreased both apoptosis and fibrosis (histology and transcriptomics) when compared to intramyocardial administration of EV alone. These data thus strengthen the concept that inclusion of EV into a clinically useable biomaterial might optimize their beneficial effects on post-ischemic cardiac repair.

Jovens em vulnerabilidades psicossociais: grupo como lugar de acolhimento e subjetivação política / Jóvenes en vulnerabilidades psicosociales: grupo como un sitio de recepción e subjetivación política / Young people in psychosocial vulnerabilities: the group as a device for psychological support and political subjectivation

RESUMO. Este artigo visa relatar uma experiência de estágio realizado em um Serviço de Convivência e Fortalecimento de Vínculos (SCFV) junto a jovens de periferias da cidade de Florianópolis (SC), de modo a problematizar as possibilidades e desafios do uso do dispositivo grupal como instrumento de intervenção psicossocial. Este serviço, vinculado à Proteção Social Básica da Política Nacional de Assistência Social (PNAS), tem como objetivo prevenir as situações de riscos e vulnerabilidades, bem como fortalecer os laços familiares e comunitários. Por meio da intervenção grupal, buscamos, junto com estes(as) jovens, criar um espaço de elaboração psíquica e política sobre temas significativos para suas vidas e para a atual sociedade. Apostamos na ideia de que as oficinas propiciaram a construção de um espaço coletivo que servisse de acolhimento ao sofrimento ético-político destes(as) jovens, subsidiando um afago às dores da vida e, também, servindo de catalisador aos processos de subjetivação política frente às iniquidades sociais que atravessam, sistematicamente, o cotidiano destes(as) jovens. Neste trabalho, trazemos reflexões em torno das potencialidades que o dispositivo grupal pode desencadear na constituição do sujeito, compreendendo-o como uma profícua ferramenta de intervenção psicossocial de escuta, acolhimento, fortalecimento comunitário e protagonismo político.

RESUMEN. Este artículo tiene por objeto relatar una experiencia realizada en un Servicio de Convivencia y Fortalecimiento de Vínculos (SCFV) junto a jóvenes de periferias de la ciudad de Florianópolis (SC), de modo a problematizar las posibilidades y desafíos del uso del dispositivo grupal como instrumento intervención psicosocial. Este servicio, vinculado a la Protección Social Básica de la Política Nacional de Asistencia Social (PNAS), tiene como objetivo prevenir las situaciones de riesgos y vulnerabilidades, así como fortalecer los lazos familiares y comunitarios. Por medio de la intervención grupal, buscamos, junto con estos jóvenes, crear un espacio de elaboración psíquica y política sobre temas significativos para sus vidas y para la actual sociedad. Apostamos en la idea de que los encuentros propiciaron la construcción de un espacio colectivo que sirviera de acogida al sufrimiento ético-político de estos jóvenes, subsidiando un ahogo a los dolores de la vida y, también, sirviendo de catalizador a los procesos de subjetivación política frente a las iniquidades sociales que atraviesan sistemáticamente el cotidiano de estos jóvenes. En este trabajo, traemos reflexiones en torno a las potencialidades que el dispositivo grupal puede desencadenar en la constitución del sujeto, comprendiéndolo como una útil herramienta de intervención psicosocial de escucha, acogida, fortalecimiento comunitario y protagonismo político.

ABSTRACT. This article aimed to report an experience developed at a Service of Coexistence and Strengthening of Bonds (SCSB) with young people from outskirts of the city of Florianópolis (SC) problematizing the possibilities and challenges of the use of the group as a psychosocial intervention device. This service, linked to the Basic Social Protection of the National Social Assistance Policy, aims to prevent situations of risks and vulnerabilities, as well as strengthen family and community bonds. Through group intervention, we sought, along with these young people, to create a space of psychic and political elaboration on themes that are significant for their lives and for the current society. We believe that the workshops allowed the construction of a collective space that served as support for the ethical-political suffering of these young people, and also served as a catalyst for the processes of political subjectification fighting the social inequities that permeate the daily lives of these young people. In this work, we brought reflections about the potential that the group device can trigger in the constitution of the subject, understanding it as a useful tool for psychosocial intervention of listening, support, community strengthening and political protagonism.

Fatores contribuintes para eventos gastrointestinais e obstrução de sonda enteral identificados e analisados a partir de registros eletrônicos de saúde de pacientes hospitalizados / Contributing factors for gastrointestinal events and enteral probe obstruction identified and analyzed from electronic health records of hospitalized patients

Objetivo: Identificar e analisar os fatores contribuintes para os eventos gastrointestinais e de obstrução de sonda em pacientes hospitalizados em uso de medicamentos por sonda enteral. Método: Estudo observacional transversal realizado através de consulta aos prontuários eletrônicos de pacientes hospitalizados (clínicos e críticos) admitidos no ano de 2018 e que fizeram uso de medicamentos por sonda enteral em um hospital público geral de médio porte e média complexidade do interior de São Paulo (Brasil), em busca dos eventos adversos e de seus fatores contribuintes. Resultados: em 2018 houve 1.735 hospitalizações, das quais 386 (22,2%) contemplaram os critérios de inclusão. Os pacientes, em sua maioria, eram homens (54,4%), idosos (72,8%), de grau fundamental incompleto (48,4%), de baixo peso (35,5%), hipertensos (55,4%), diabéticos (30,6%), admitidos por doenças do aparelho respiratório (42,7%); ficaram hospitalizados por mais de 15 dias (37,3%), começaram a usar sonda enteral durante a hospitalização (51,6%) por disfagia (49,7%) e permaneceram em uso de sonda até o momento da alta (65,8%). A taxa de obstrução de sonda foi de 10,4%, sendo 53,5% notificadas e 81,4% resultaram em dano moderado. Foram encontrados três fatores contribuintes relacionados à sonda enteral, cinco relacionados à nutrição enteral e oito relacionados aos medicamentos, sendo os principais, respectivamente, o posicionamento gástrico da sonda, a presença de proteína inteira na nutrição enteral e o uso de fármacos pouco ou insolúveis em água. Com relação aos eventos gastrointestinais, a taxa de diarreia foi de 63,2%, a de vômito 27,2%; a de constipação 26,2%; a de dor abdominal 16,6%; a de distensão abdominal 13,0% e a de náusea 12,7%. Conclusão: Os fatores relacionados ao paciente são os mais representativos, porém nem todos são modificáveis. Os relacionados à nutrição, em geral, estão vinculados às propriedades da própria nutrição (viscosidade, quantidade de calorias e fibras, presença de proteínas inteiras etc.), que é selecionada pelo nutricionista com base nas necessidades do paciente. Os medicamentos podem contribuir para os eventos por sua forma farmacêutica, acidez, solubilidade em água, osmolaridade, presença de sorbitol, por reação adversa, interação medicamentosa e pelo seu mecanismo de ação/classe terapêutica. Esses fatores podem ser um ponto importante a ser trabalhado em conjunto pela equipe multiprofissional. As informações geradas por este estudo poderão ser utilizadas como gatilhos, que sinalizarão pacientes mais vulneráveis e suscetíveis à ocorrência dos eventos, além de contribuírem para a tomada de decisão clínica para preveni-los.

Objective: To identify and analyze factors which contribute to the occurrence of gastrointestinal events and tube obstruction in hospitalized patients using medication via enteral feeding tubes. Method: It was a cross-sectional study done with the reviewing of electronic medical records of hospitalized patients (clinical and critical) admitted in 2018 and who underwent enteral nutrition in a medium-sized and medium-complexity general public hospital in the countryside of São Paulo (Brazil), in search of adverse events and their contributing factors. Results: In 2018 there were 1735 hospitalizations, of which 386 (22.2%) met the inclusion criteria. Patients were mostly men (54.4%), elderly (72.8%), white (73.1%), primary and middle school dropouts (48.4%), underweight (35.5%), hypertensive (55.4%), diabetic (30.6%) and admitted for respiratory diseases (42.7%). The majority were hospitalized for more than 15 days (37.3%), started using enteral tubes during hospitalization (51.6%) due to dysphagia (49.7%) and remained using a feeding tube until discharge (65, 8%). Probe obstruction rate was 10.4%, with 53.5% being reported and 81.4% resulting in moderate damage. Three contributing factors were found related to the use of the device, five related to the enteral nutrition and eight related to medications, the main ones being, respectively, the gastric placement of the tube, the presence of complete protein in the diet and the use of poorly water-soluble or water-insoluble drugs. With regard to gastrointestinal events, the rate of diarrhea was 63.2%, vomiting 27.2%; constipation 26.2%; abdominal pain 16.6%; abdominal distension 13.0% and náusea 12.7%. Conclusion: The most representative contributing factors are those related to the patient, but not all are modifiable. Those related to the diet, in general, are linked to the properties of the diet itself (viscosity, number of calories and fiber, presence of complete proteins, etc.) and are selected by the nutritionist based on the patient's needs. Drugs can contribute to events for a variety of reasons: due to their pharmaceutical form, acidity, water solubility, osmolarity, presence of sorbitol, adverse reactions, drug interactions and their mechanism of action/therapeutic class. Drug-related contributing factors may be an important point to be worked on together by the multidisciplinary team. The information generated by this study can be used as trigger tools which will help identify patients who are more vulnerable and susceptible to the occurrence of adverse events, in addition to contributing to clinical decision-making to prevent them.

Fatores contribuintes para eventos gastrointestinais e obstrução de sonda enteral identificados e analisados a partir de registros eletrônicos de saúde de pacientes hospitalizados / Contributing factors for gastrointestinal events and enteral probe obstruction identified and analyzed from electronic health records of hospitalized patients

Objetivo: Identificar e analisar os fatores contribuintes para os eventos gastrointestinais e de obstrução de sonda em pacientes hospitalizados em uso de medicamentos por sonda enteral. Método: Estudo observacional transversal realizado através de consulta aos prontuários eletrônicos de pacientes hospitalizados (clínicos e críticos) admitidos no ano de 2018 e que fizeram uso de medicamentos por sonda enteral em um hospital público geral de médio porte e média complexidade do interior de São Paulo (Brasil), em busca dos eventos adversos e de seus fatores contribuintes. Resultados: em 2018 houve 1.735 hospitalizações, das quais 386 (22,2%) contemplaram os critérios de inclusão. Os pacientes, em sua maioria, eram homens (54,4%), idosos (72,8%), de grau fundamental incompleto (48,4%), de baixo peso (35,5%), hipertensos (55,4%), diabéticos (30,6%), admitidos por doenças do aparelho respiratório (42,7%); ficaram hospitalizados por mais de 15 dias (37,3%), começaram a usar sonda enteral durante a hospitalização (51,6%) por disfagia (49,7%) e permaneceram em uso de sonda até o momento da alta (65,8%). A taxa de obstrução de sonda foi de 10,4%, sendo 53,5% notificadas e 81,4% resultaram em dano moderado. Foram encontrados três fatores contribuintes relacionados à sonda enteral, cinco relacionados à nutrição enteral e oito relacionados aos medicamentos, sendo os principais, respectivamente, o posicionamento gástrico da sonda, a presença de proteína inteira na nutrição enteral e o uso de fármacos pouco ou insolúveis em água. Com relação aos eventos gastrointestinais, a taxa de diarreia foi de 63,2%, a de vômito 27,2%; a de constipação 26,2%; a de dor abdominal 16,6%; a de distensão abdominal 13,0% e a de náusea 12,7%. Conclusão: Os fatores relacionados ao paciente são os mais representativos, porém nem todos são modificáveis. Os relacionados à nutrição, em geral, estão vinculados às propriedades da própria nutrição (viscosidade, quantidade de calorias e fibras, presença de proteínas inteiras etc.), que é selecionada pelo nutricionista com base nas necessidades do paciente. Os medicamentos podem contribuir para os eventos por sua forma farmacêutica, acidez, solubilidade em água, osmolaridade, presença de sorbitol, por reação adversa, interação medicamentosa e pelo seu mecanismo de ação/classe terapêutica. Esses fatores podem ser um ponto importante a ser trabalhado em conjunto pela equipe multiprofissional. As informações geradas por este estudo poderão ser utilizadas como gatilhos, que sinalizarão pacientes mais vulneráveis e suscetíveis à ocorrência dos eventos, além de contribuírem para a tomada de decisão clínica para preveni-los

Objective: To identify and analyze factors which contribute to the occurrence of gastrointestinal events and tube obstruction in hospitalized patients using medication via enteral feeding tubes. Method: It was a cross-sectional study done with the reviewing of electronic medical records of hospitalized patients (clinical and critical) admitted in 2018 and who underwent enteral nutrition in a medium-sized and medium-complexity general public hospital in the countryside of São Paulo (Brazil), in search of adverse events and their contributing factors. Results: In 2018 there were 1735 hospitalizations, of which 386 (22.2%) met the inclusion criteria. Patients were mostly men (54.4%), elderly (72.8%), white (73.1%), primary and middle school dropouts (48.4%), underweight (35.5%), hypertensive (55.4%), diabetic (30.6%) and admitted for respiratory diseases (42.7%). The majority were hospitalized for more than 15 days (37.3%), started using enteral tubes during hospitalization (51.6%) due to dysphagia (49.7%) and remained using a feeding tube until discharge (65, 8%). Probe obstruction rate was 10.4%, with 53.5% being reported and 81.4% resulting in moderate damage. Three contributing factors were found related to the use of the device, five related to the enteral nutrition and eight related to medications, the main ones being, respectively, the gastric placement of the tube, the presence of complete protein in the diet and the use of poorly water-soluble or water-insoluble drugs. With regard to gastrointestinal events, the rate of diarrhea was 63.2%, vomiting 27.2%; constipation 26.2%; abdominal pain 16.6%; abdominal distension 13.0% and náusea 12.7%. Conclusion: The most representative contributing factors are those related to the patient, but not all are modifiable. Those related to the diet, in general, are linked to the properties of the diet itself (viscosity, number of calories and fiber, presence of complete proteins, etc.) and are selected by the nutritionist based on the patient's needs. Drugs can contribute to events for a variety of reasons: due to their pharmaceutical form, acidity, water solubility, osmolarity, presence of sorbitol, adverse reactions, drug interactions and their mechanism of action/therapeutic class. Drug-related contributing factors may be an important point to be worked on together by the multidisciplinary team. The information generated by this study can be used as trigger tools which will help identify patients who are more vulnerable and susceptible to the occurrence of adverse events, in addition to contributing to clinical decision-making to prevent them

Impactos da intervenção neuropsicológica em idosos com comprometimento cognitivo leve / The impact of neuropsychological intervention in mild cognitive impairment

Objetivo: Investigar os efeitos da intervenção neuropsicológica em grupo na cognição, no estado psicológico e na qualidade de vida de idosos com Comprometimento Cognitivo Leve. Método: Estudo controlado, randomizado, cego ao avaliador. 78 idosos, divididos entre os grupos Neuropsicológico e Controle, foram avaliados por: entrevista semiestruturada, Exame Cognitivo de Addenbrooke, Índice de Katz, Escala de Lawton e Brody, Escala de Depressão Geriátrica, Inventário de Ansiedade de Beck, Escala de Desenvolvimento Pessoal, WHOQOL-bref e WHOQOL-old. Resultados: Após a intervenção, o Grupo Neuropsicológico apresentou: melhora nos subtestes cognitivos e no escore total; redução na frequência de sintomas associados à ansiedade e à depressão; melhor bem-estar psicológico e qualidade de vida. A pesquisa aponta estratégias de intervenção úteis para melhora da condição geral desses pacientes e para reabilitação de áreas prejudicadas. Conclusão: Concluiu-se existir relação entre a intervenção neuropsicológica e a melhora no desempenho cognitivo, psicológico e qualidade de vida em idosos com Comprometimento Cognitivo Leve.(AU)

Objective: We sought to investigate a neuropsychological intervention focused on improving cognition, psychological aspects, and quality of life of elderly people with Mild Cognitive Impairment. Method: A controlled and randomized study, blind to the evaluator, was executed. We evaluated 78 elderly people, divided into the Neuropsychological and Control groups, through: a semi-struc- tured interview, Addenbrooke's Cognitive Examination, Katz Index, Lawton and Brody Scale, Geriatric Depression Scale, Beck Anxiety Inventory, Personal Development Scale, WHOQOL-bref and WHOQOL-old. Results: After the intervention, the Neuropsychological Group showed: improvement in the cognitive subtests and in the total score; reduction in the frequency of symptoms associated with anxiety and depression; a better psychological well-being and quality of life. The research highlights useful intervention strategies for improving the general condition of these patients and rehabilitating damaged areas. Conclusion: We concluded that there is a relationship between neuropsychological intervention and improvement in cognitive and psychological performance, as well as in the quality of life in elderly people with Mild Cognitive Impairment.(AU)

Adoptive immunotherapy with double-bright (CD56bright /CD16bright ) expanded natural killer cells in patients with relapsed or refractory acute myeloid leukaemia: a proof-of-concept study.

Patients with acute myeloid leukaemia (AML) have a five-year survival rate of 28·7%. Natural killer (NK)-cell have anti-leukaemic activity. Here, we report on a series of 13 patients with high-risk R/R AML, treated with repeated infusions of double-bright (CD56bright /CD16bright ) expanded NK cells at an academic centre in Brazil. NK cells from HLA-haploidentical donors were expanded using K562 feeder cells, modified to express membrane-bound interleukin-21. Patients received FLAG, after which cryopreserved NK cells were thawed and infused thrice weekly for six infusions in three dose cohorts (106 -107 cells/kg/infusion). Primary objectives were safety and feasibility. Secondary endpoints included overall response (OR) and complete response (CR) rates at 28-30 days after the first infusion. Patients received a median of five prior lines of therapy, seven with intermediate or adverse cytogenetics, three with concurrent central nervous system (CNS) leukaemia, and one with concurrent CNS mycetoma. No dose-limiting toxicities, infusion-related fever, or cytokine release syndrome were observed. An OR of 78·6% and CR of 50·0% were observed, including responses in three patients with CNS disease and clearance of a CNS mycetoma. Multiple infusions of expanded, cryopreserved NK cells were safely administered after intensive chemotherapy in high-risk patients with R/R AML and demonstrated encouraging outcomes.

Extracellular vesicles from human cardiovascular progenitors trigger a reparative immune response in infarcted hearts.

AIMS: The cardioprotective effects of human induced pluripotent stem cell-derived cardiovascular progenitor cells (CPC) are largely mediated by the paracrine release of extracellular vesicles (EV). We aimed to assess the immunological behaviour of EV-CPC, which is a prerequisite for their clinical translation. METHODS AND RESULTS: Flow cytometry demonstrated that EV-CPC expressed very low levels of immune relevant molecules including HLA Class I, CD80, CD274 (PD-L1), and CD275 (ICOS-L); and moderate levels of ligands of the natural killer (NK) cell activating receptor, NKG2D. In mixed lymphocyte reactions, EV-CPC neither induced nor modulated adaptive allogeneic T cell immune responses. They also failed to induce NK cell degranulation, even at high concentrations. These in vitro effects were confirmed in vivo as repeated injections of EV-CPC did not stimulate production of immunoglobulins or affect the interferon (IFN)-γ responses from primed splenocytes. In a mouse model of chronic heart failure, intra-myocardial injections of EV-CPC, 3 weeks after myocardial infarction, decreased both the number of cardiac pro-inflammatory Ly6Chigh monocytes and circulating levels of pro-inflammatory cytokines (IL-1α, TNF-α, and IFN-γ). In a model of acute infarction, direct cardiac injection of EV-CPC 2 days after infarction reduced pro-inflammatory macrophages, Ly6Chigh monocytes, and neutrophils in heart tissue as compared to controls. EV-CPC also reduced levels of pro-inflammatory cytokines IL-1α, IL-2, and IL-6, and increased levels of the anti-inflammatory cytokine IL-10. These effects on human macrophages and monocytes were reproduced in vitro; EV-CPC reduced the number of pro-inflammatory monocytes and M1 macrophages, while increasing the number of anti-inflammatory M2 macrophages. CONCLUSIONS: EV-CPC do not trigger an immune response either in in vitro human allogeneic models or in immunocompetent animal models. The capacity for orienting the response of monocyte/macrophages towards resolution of inflammation strengthens the clinical attractiveness of EV-CPC as an acellular therapy for cardiac repair.

A PUERICULTURA NO PRIMEIRO ANO DE VIDA ­ UMA AVALIAÇÃO NA ATENÇÃO PRIMÁRIA EM SAÚDE / CHILDCARE IN THE FIRST YEAR OF LIFE-AN EVALUATION IN PRIMARY HEALTH CARE

Objetivo: avaliar a frequência de consultas no primeiro ano da criança e relacionar com as características maternas, de pré-natal e perinatais. Métodos: Coorte de crianças nascidas entre maio e outubro de 2015 que realizaram no mínimo uma consulta na Unidade Básica de Saúde até seus 13 meses incompletos. As informações maternas, de pré-natal e perinatais foram obtidas do SINASC e o número total e o tipo de consulta pelo prontuário da UBS. Foram realizadas análise descritiva das variáveis e testes de associação das características maternas, informações de pré-natal e perinatais com o número de consultas no primeiro ano. Resultados: das 237 crianças nascidas no período, 35 (14,7%) consultaram até os 13 meses incompletos (m=7,6 atendimentos). Destas, 22 (62,9%) realizaram no mínimo 7 atendimentos de puericultura. A menor escolaridade materna esteve associada a um maior número de consultas no primeiro ano de vida (p=0,050) e houve correlação do número de consultas de pré-natal com as de puericultura (p=0,044). Conclusão: o maior número de atendimentos durante o primeiro ano de vida da criança está associado à menor escolaridade materna ao mesmo tempo em que, o vínculo estabelecido durante o pré-natal, ocasionou um maior número de consultas de puericultura.

Objective: To evaluate the frequency of consultations in the first year of the child and to relate to the maternal, prenatal and perinatal characteristics.Methods: Cohort of children born between May and October 2015 who performed at least one visit to the Basic Health Unit until their 13 months. Maternal, prenatal and perinatal information were obtained from the SINASC and the total number and type of consultation by the UBS medical record. Descriptive analysis of the variables and tests of association of maternal characteristics, prenatal and perinatal information with the number of visits in the first year were performed.Results: Of the 237 children born, 35 (14.7%) consulted until the incomplete 13 months (m = 7.6 visits). Of these, 22 (62.9%) performed at least 7 childcare services. Maternal schooling was associated with a higher number of visits in the first year (p=0.050) and there was a correlation between the number of prenatal consultations and those of childcare (p = 0.044). Conclusions: The higher number of visits during the first year of life of the child is associated with lower maternal schooling, while the link established during the prenatal period has resulted in a greater number of childcare consultations.

Proneural and mesenchymal glioma stem cells display major differences in splicing and lncRNA profiles.

Therapy resistance and recurrence in high-grade gliomas are driven by their populations of glioma stem cells (GSCs). Thus, detailed molecular characterization of GSCs is needed to develop more effective therapies. We conducted a study to identify differences in the splicing profile and expression of long non-coding RNAs in proneural and mesenchymal GSC cell lines. Genes related to cell cycle, DNA repair, cilium assembly, and splicing showed the most differences between GSC subgroups. We also identified genes distinctly associated with survival among patients of mesenchymal or proneural subgroups. We determined that multiple long non-coding RNAs with increased expression in mesenchymal GSCs are associated with poor survival of glioblastoma patients. In summary, our study established critical differences between proneural and mesenchymal GSCs in splicing profiles and expression of long non-coding RNA. These splicing isoforms and lncRNA signatures may contribute to the uniqueness of GSC subgroups, thus contributing to cancer phenotypes and explaining differences in therapeutic responses.

Implantoplasty Enhancing Peri-implant Bone Stability Over a 3-Year Follow-up: A Case Series.

Implantoplasty has been claimed as a promising strategy to treat peri-implantitis and prevent progressive peri-implant bone loss. Consequently, the aim of the present case series is to exhibit the clinical outcomes of a 3-year-follow-up resective and implantoplasty therapy applying a novel platform-switch concept to preserve peri-implant tissue integrity and counteract progressive bone loss. Four patients who underwent dental implant therapy and were diagnosed with peri-implantitis were treated through access flap surgery, a modified implantoplasty, bone recontouring, and surface decontamination. The radiographic and clinical parameters recorded before and during the 3-year follow-up were: marginal bone loss (MBL) as the primary endpoint, bleeding on probing index (BOP), probing depth (PD), presence of suppuration, pain, mobility, and fracture. The 3-year follow-up exhibited peri-implant bone stability in all cases (100%) showing radiographically an MBL reduction (mean) of 0.8 ± 0.5 mm (mesial) and 0.5 ± 0.3 mm (distal). Mean PD reduction was 4.75 ± 1 mm and mean BOP was reduced by 71%. Pain and suppuration were resolved in all cases. None of the cases reported implant fracture or mobility after the modified implantoplasty therapy. The present case series demonstrated that this modified implantoplasty can be more than a surface decontamination therapy where the narrow and smooth exposed implant surface can counteract peri-implantitis alterations providing favorable biologic conditions to maintain stability of peri-implant tissues.

The Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer-The Impact in Intratumoral Heterogeneity.

Purpose: Intratumoral genetic heterogeneity (ITGH) is a common feature of solid tumors. However, little is known about the effect of neoadjuvant chemoradiation (nCRT) in ITGH of rectal tumors that exhibit poor response to nCRT. Here, we examined the impact of nCRT in the mutational profile and ITGH of rectal tumors and its adjacent irradiated normal mucosa in the setting of incomplete response to nCRT. Methods and Materials: To evaluate ITGH in rectal tumors, we analyzed whole-exome sequencing (WES) data from 79 tumors obtained from The Cancer Genome Atlas (TCGA). We also compared matched peripheral blood cells, irradiated normal rectal mucosa and pre and post-treatment tumor samples (PRE-T and POS-T) from one individual to examine the iatrogenic effects of nCRT. Finally, we performed WES of 7 PRE-T/POST-T matched samples to examine how nCRT affects ITGH. ITGH was assessed by quantifying subclonal mutations within individual tumors using the Mutant-Allele Tumor Heterogeneity score (MATH score). Results: Rectal tumors exhibit remarkable ITGH that is ultimately associated with disease stage (MATH score stage I/II 35.54 vs. stage III/IV 44.39, p = 0.047) and lymph node metastasis (MATH score N0 35.87 vs. N+ 45.79, p = 0.026). We also showed that nCRT does not seem to introduce detectable somatic mutations in the irradiated mucosa. Comparison of PRE-T and POST-T matched samples revealed a significant increase in ITGH in 5 out 7 patients and MATH scores were significantly higher after nCRT (median 41.7 vs. 28.8, p = 0.04). Finally, we were able to identify a subset of "enriched mutations" with significant changes in MAFs between PRE-T and POST-T samples. These "enriched mutations" were significantly more frequent in POST-T compared to PRE-T samples (92.9% vs. 7.1% p < 0.00001) and include mutations in genes associated with genetic instability and drug resistance in colorectal cancer, indicating the expansion of tumor cell subpopulations more prone to resist to nCRT. Conclusions: nCRT increases ITGH and may result in the expansion of resistant tumor cell populations in residual tumors. The risk of introducing relevant somatic mutations in the adjacent mucosa is minimal but non-responsive tumors may have potentially worse biological behavior when compared to their untreated counterparts. This was an exploratory study, and due to the limited number of samples analyzed, our results need to be validated in larger cohorts.

O enfermeiro na detecção dos sinais e sintomas que antecedem sepse em pacientes na enfermaria / The nurse approach towards the detection of antecedent signs and symptoms of sepsis in patients at a nursing ward / El enfermero en la detección de los señales y síntomas que antecede a sepse en pacientes en la enfermería

Objective: The study's goal has been to describe the antecedent signs and symptoms of sepsis in patients hospitalized in the Medical Clinic of a Federal Hospital in Rio de Janeiro city, which are identified by a Registered Nurse; to analyze how the Nurse correlates the signs and symptoms with Sepsis-1, Sepsis-2 and Sepsis-3. Methods: It is a descriptive study with a quantitative approach; the population were 10 Registered Nurses who worked daytime shifts in the nursing ward. Data collection was performed through a structured questionnaire, addressing the identification of signs and symptoms that precede sepsis, including the characteristics and peculiarities of sepsis. Results: The Nurses have adequate understanding regarding the concept of sepsis, although they have showed difficulties in correlating some of the signs and symptoms. Conclusion: The Nurses are aware that sepsis is a health problem and that they provide direct care to the patient, therefore, it is important to identify the signs and symptoms that precede it in order to offer quality assistance and to help reducing new cases

Objetivo: Descrever os sinais e sintomas que antecedem a sepse em pacientes internados na Clínica Médica de um Hospital Federal no Rio de Janeiro identificados pelo Enfermeiro; analisar como o Enfermeiro correlaciona os sinais e sintomas com a Sepsis-1, Sepsis-2 e Sepsis-3. Métodos: Estudo descritivo com abordagem quantitativa, a população foram 10 Enfermeiros em plantões diurnos na enfermaria da Clínica. A coleta de dados foi um questionário estruturado, abordando identificação dos sinais e sintomas que antecedem a sepse, englobando as características e particularidades da sepse. Resultados: Evidenciou-se que possuem entendimento sobre o conceito de sepse, entretanto apresentaram dificuldades em correlacionar alguns dos sinais e sintomas dos tipos de sepse. Conclusão: Ciente que a sepse é um problema de saúde e o Enfermeiro presta cuidado direto ao paciente, percebe-se a importância na identificação dos sinais e sintomas que a antecedem para oferecer assistência de qualidade e auxiliar na redução dos casos

Objetivo: Describe los síntomas y antecedentes de la sepsis en pacientes internados en la Clínica Médica de un Hospital Federal en Río de Janeiro por el enfermero; analizar cómo el enfermero correlaciona los signos y síntomas con Sepsis-1, Sepsis-2 y Sepsis-3. Métodos: Estudio descriptivo con abordaje cuantitativo, la población fue 10 enfermeros en turnos diurnos en la enfermería de la Clínica. La recolección de datos fue un cuestionario estructurado, abordando identificación de los signos y síntomas que anteceden a la sepsis, englobando las características y particularidades de la sepsis. Resultados: Tienen un entendimiento adecuado sobre el concepto de sepsis, sin embargo, presentan dificultades en correlacionar algunos de los signos y síntomas. Conclusión: Es consciente de que la sepsis es un problema de salud y el enfermero presta atención directa al paciente, se percibe la importancia en la identificación de los signos y síntomas que la anteceden para ofrecer asistencia de calidad y auxiliar en la reducción de los casos

Subjetivação política e aumento da potência de ação: quem são os usuários dos CRAS? / Political subjectivity and the increase of the power of action: who are the users of the social assistance reference center (CRAS)? / Subjetivación política y mayor poder de acción: ¿quiénes son los usuarios del CRAS?

Este artigo é parte de uma pesquisa mais ampla, cujo objetivo geral foi identificar os discursos sobre as práticas de trabalho das equipes nos Centro de Referência em Assistência Social (CRAS) em diferentes municípios do Brasil, buscando problematizar os avanços no que se refere à promoção de experiências coletivas nesse contexto. Neste artigo, focamos no material de dois municípios da Região Sul do País, no que diz respeito a quem é o usuário na perspectiva dos trabalhadores da Assistência Social, por meio de entrevistas coletivas com cada equipe, em cada equipamento. Com base na Psicologia sócio-histórica e das ideias de Jacques Rancière, analisamos os discursos, construímos cenas como material de pesquisa e, com elas, dialogamos categorias analíticas. Os resultados trazem duas categorias: a experiência da subjetivação política e a potência dos usuários da Assistência Social, apontando possibilidades para promoção da cidadania nos fazeres psicossociais.

This article is part of a broader research, whose general objective was to identify the discourses on the work practices of the teams at the Reference Center of Social Assistance (Portuguese acronym: CRAS) in different Brazilian cities, aiming to problematize the advances regarding the development of collective experiences in that context. In this article, we focus on material from two cities in the southern region of the country, regarding who is the user within the perspective of Social Assistance workers, performing collective interviews with each team, in each sector. We have analyzed the discourses based on Jacques Rancière’s socio-historical Psychology and ideas, we built scenes as research material and proposed the dialogue between analytical categories. The results brought two categories: the experience of political subjectivation and the power of social assistance users, pointing out possibilities for the promotion of citizenship in psychosocial activities.

Este artículo es parte de una investigación más amplia, cuyo objetivo general fue identificar los discursos sobre las prácticas de trabajo de los equipos en el Centro de Referencia de Asistencia Social (CRAS) en diferentes municipios de Brasil, buscando problematizar los avances con respecto a la promoción de experiencias colectivas en ese contexto. En este artículo, nos enfocamos en el material de dos municipios de la región sur del país, con respecto a quién es el usuario desde la perspectiva de los trabajadores sociales, a través de entrevistas colectivas con cada equipo en cada unidad. A partir de la Psicología sociohistórica e ideas de Jacques Rancière, analizamos los discursos, construimos escenas como material de investigación y dialogamos, con ellas, categorías analíticas. Los resultados trajeron dos categorías: la experiencia de la subjetivación política y el poder de los usuarios de la Asistencia Social, señalando las posibilidades para la promoción de la ciudadanía en las actividades psicosociales.

Antagonism between the RNA-binding protein Musashi1 and miR-137 and its potential impact on neurogenesis and glioblastoma development.

RNA-binding proteins (RBPs) and miRNAs are critical gene expression regulators that interact with one another in cooperative and antagonistic fashions. We identified Musashi1 (Msi1) and miR-137 as regulators of a molecular switch between self-renewal and differentiation. Msi1 and miR-137 have opposite expression patterns and functions, and Msi1 is repressed by miR-137. Msi1 is a stem-cell protein implicated in self-renewal while miR-137 functions as a proneuronal differentiation miRNA. In gliomas, miR-137 functions as a tumor suppressor while Msi1 is a prooncogenic factor. We suggest that the balance between Msi1 and miR-137 is a key determinant in cell fate decisions and disruption of this balance could contribute to neurodegenerative diseases and glioma development. Genomic analyses revealed that Msi1 and miR-137 share 141 target genes associated with differentiation, development, and morphogenesis. Initial results pointed out that these two regulators have an opposite impact on the expression of their target genes. Therefore, we propose an antagonistic model in which this network of shared targets could be either repressed by miR-137 or activated by Msi1, leading to different outcomes (self-renewal, proliferation, tumorigenesis).