Revisão Integrativa: amenorreia lactacional como método contraceptivo para puérperas

Este estudo tem como objetivo analisar as evidências científicas na literatura sobre o método da amenorreia lactacional como contraceptivo para puérperas. Trata-se de um estudo bibliográfico, tipo revisão integrativa, realizado através de busca sistemática no mês de março na BVS, nas bases de dados LILACS, MEDLINE, BDENF e no SCIELO com os descritores em saúde. A amostra foi composta por artigos originais na íntegra, publicados entre o ano de 2002 e 2018, em idioma português, inglês e espanhol, apresentada em figura e analisada de forma descritiva. Foi obtido um total de 508 artigos, após inserir os critérios de inclusão e realizar a análise de elegibilidade, obtiveram-se seis artigos para revisão. Diante da análise do estudo foi possível observar que este método contraceptivo pode ser empregado de forma segura durante o puerpério, levando a contracepção e extensão do período da amamentação, mas existe uma grande dificuldade em estabelecê-lo, pois, o desconhecimento da ação contraceptiva é a principal barreira para sua utilização, observa-se a necessidade do aprimoramento científico dos profissionais de saúde para realizar sua indicação.

Aplicação do IVCF-20 adaptado para o telefone como estratégia de avaliação em tempos de Covid-19 / Application of the ivcf-20 adapted for the phone as an evaluation strategy in times of Covid-19

Introdução: o risco de fragilidade em idosos é algo que deve ser monitorizado, sendo importante seu acompanhamento pelo sistema de saúde, especialmente durante uma pandemia. Objetivo: estimar o risco de fragilidade em idosos comunitários adscritos de uma Unidade Básica de Saúde (UBS) durante a pandemia de COVID-19 com a aplicação do questionário de Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) adaptado para telefone. Métodos: estudo transversal com 152 idosos (≥ 60 anos) de ambos os sexos, cadastrados na Estratégia em Saúde da Família referente a uma UBS na região urbana de Londrina-PR. A coleta de dados foi realizada em etapa única, durante contato telefônico, utilizando para o registro de informações o IVCF-20, sendo realizadas três tentativas de contato telefônico. Resultados: 68,4% dos idosos eram hipertensos e 24,3% diabéticos. Com relação à moradia, 94,7% dos idosos "não" moram sozinhos e 70,4% possuem uma "boa percepção de saúde". Para classificação do IVCF-20, 73,0% dos homens são classificados como "robustos", quando comparados às mulheres (51,7%). Conclusão: a aplicação do IVCF-20 por telefone apresenta capacidade de uso em momentos de risco para a saúde pública, como a pandemia de COVID-19.

Introduction: The risk of frailty in the elderly is something that must be monitored, and its monitoring by the health system is important, especially during a pandemic. Objective: to estimate the risk of frailty in community-dwelling elderly people enrolled in a Basic Health Unit (BHU) during the COVID-19 pandemic with the application of the Clinical-Functional Vulnerability Index-20 (CFVI-20) questionnaire adapted for telephone use. Methods: cross-sectional study with 152 elderly (≥ 60 years) of both sexes, registered in the Family Health Strategy referring to a BHU in the urban region of Londrina-PR. Data collection was carried out in a single step, during telephone contact, using the CFVI-20 to record information, with three telephone contact attempts being made. Results: 68.4% of the elderly were hypertensive and 24.3% diabetic. With regard to housing, 94.7% of the elderly "don't" live alone and 70.4% have a "good perception of health". For the CFVI-20 classification, 73.0% of men are classified as "robust" when compared to women (51.7%). Conclusion: the application of the CFVI-20 by telephone is capable of being used in moments of risk to public health, such as the COVID-19 pandemic.

Motor learning in visual impaired individuals during a coincident timing task in a non-immersive virtual reality / Aprendizagem motora em indivíduos com deficiência visual em uma tarefa de timing coincident em realidade virtual não imersiva

Introduction: virtual reality (VR) is used nowadays as an assessment and intervention tool in rehabilitation. One of the skills that can be assessed through VR is coincident timing (perceptual-motor ability to execute a motor response in synchrony with an external stimulus). Visually impaired (VI) people require this synchronization of movements with external objects in their daily and leisure activities. Objective: to investigate the performance of VI individuals in a VR coincident timing task. Methods: sixty individuals over 18 years of age participated in this study: 20 with VI, 20 without VI but blindfolded and 20 individuals without VI that used visual feedback (without blindfold). A semi-structured interview and a virtual coincident timing task were used. Results: although VI individuals started the task with the worst performance (Absolute error = VI group 945ms x blindfolded group 591ms x without blindfold group, 557ms), they improved performance throughout the task, as did the other groups, reducing the number of errors (mean absolute error= 698ms to 408ms). Furthermore, all groups presented increased task speed (mean variable error= last acquisition block 408ms x immediate transfer 227ms x late transfer 247ms). Conclusion: individuals with VI had difficulties at the beginning of the proposed task, but with practice they were able to adapt to the task with an improved of performance (observed by the decrease in error time). The auditory feedback was sufficient to allow adaptation to the task which improved participant performance with VI.

Introdução: A realidade virtual (RV) é usada atualmente como ferramenta de avaliação e intervenção na reabilitação. Uma das tarefas motoras possíveis de verificar desempenho por meio da RV é o timing coincidente (habilidade perceptivo-motora de executar uma resposta motora em sincronia com um estímulo externo). Essa sincronização de movimentos com estímulos externos é importante para pessoas com deficiência visual (DV) nas tarefas diárias e de lazer.Objetivo: Investigar o desempenho de indivíduos com DV em uma tarefa de timing coincident em RV não imersiva.Método: Participaram deste estudo 60 indivíduos maiores de 18 anos: 20 com DV, 20 sem DV mas vendados e 20 indivíduos sem DV que utilizaram feedback visual (não vendado). Foi utilizada entrevista semiestruturada e uma tarefa de timing coincident no computador. Resultados: O grupo DV iniciou a tarefa com o pior desempenho (erro absoluto = grupo DV 945ms x grupo vendado 591ms x grupo não vendado 557ms), mas melhoraram ao longo da tarefa. Apesar da dificuldade inicial do grupo com DV, todos os grupos reduziram o número de erros (erro absoluto médio = 698ms para 408ms). Além disso, todos os grupos aumentaram a precisão da tarefa (erro variável médio = último bloco de aquisição 408 ms x transferência imediata 227 ms x transferência tardia 247 ms).Conclusão: Indivíduos com DV apresentaram dificuldades no início da tarefa proposta mas com a prática conseguiram se adaptar a tarefa com melhora no desempenho (observado pela diminuição no tempo de erro). Ou seja, o feedback auditivo foi suficiente para possibilitar adaptação à tarefa e melhora de desempenho dos participantes com DV.

Iniquidades sociais e de gênero nas demandas de mulheres por acolhimento / Iniquidades sociales y de género en las demandas de acogida de las mujeres / Social and gender inequalities in women's needs for user embracement

RESUMO Objetivo analisar demandas de mulheres segundo o olhar de equipes multiprofissionais. Métodos estudo qualitativo desenvolvido em Unidade de Saúde da Família de um Distrito Sanitário de Saúde em Salvador, Bahia, Brasil. Realizou-se grupo focal e o material empírico foi analisado pela técnica de Análise de Discurso. Resultados participaram da pesquisa 12 profissionais de saúde com idades entre 27 e 60 anos e atuação de dois a 13 anos na Estratégia Saúde da Família. As profissionais caracterizaram as usuárias com vulnerabilidade social e econômica e as demandas de ordem afetivo-emocional relacionadas a iniquidades de gênero, com sobrecarga do trabalho doméstico e do cuidado à família. A equipe de saúde constitui ponto de apoio e oferece acolhimento e escuta sensível. Conclusão carência afetiva e desgastes pelas funções no âmbito doméstico, familiar e pela relação com o parceiro marcam as demandas de mulheres por cuidado. Profissionais realizam práticas na perspectiva da integralidade, mas há limites institucionais e da equipe em lidar com singularidades. Construir a superação requer abrir caminhos ao empoderamento das mulheres, o que não retrata a realidade problematizada. Implicações para a prática subsidiar profissionais no atendimento ao princípio da integralidade diante de contextos de mulheres em vulnerabilidades sociais e econômicas.

RESUMEN Objetivo analizar las demandas de las mujeres desde la óptica de equipos multidisciplinarios. Métodos estudio cualitativo realizado en la Unidad de Salud de la Familia de un Distrito de Salud de Salvador, Bahía, Brasil. Se realizó un grupo focal y se analizó el material empírico mediante la técnica de Análisis del Discurso. Resultados participaron de la investigación 12 profesionales de la salud, con edades entre 27 y 60 años y actuando de dos a 13 años en la Estrategia Salud de la Familia. Los profesionales caracterizaron a los usuarios con vulnerabilidad social y económica y las demandas afectivo-emocionales relacionadas a las inequidades de género, con sobrecarga de trabajo doméstico y cuidado de la familia. El equipo de salud es un punto de apoyo y ofrece acogida y escucha sensible. Conclusión la carencia y el desgaste afectivo por las funciones domésticas, familiares y la relación de pareja marcan las demandas de cuidado de las mujeres. Los profesionales realizan prácticas desde la perspectiva de la integralidad, pero existen límites institucionales y de equipo en el abordaje de las singularidades. Construir la superación de desafíos requiere abrir caminos al empoderamiento de las mujeres, lo que no retrata la realidad problematizada. Implicaciones para la práctica subsidiar a profesionales en la atención al principio de integralidad ante contextos de mujeres en situación de vulnerabilidad social y económica.

ABSTRACT Objective to analyze the demands of women from the point of view of multi-professional teams. Methods This is a qualitative study developed in a Family Health Unit of a Health Sanitary District in Salvador, Bahia, Brazil. A focus group was conducted, and the empirical material was analyzed using the Discourse Analysis technique. Results twelve health professionals aged between 27 and 60 years and working for two to 13 years in the Family Health Strategy participated in the research. The professionals characterized the users with social and economic vulnerability and the demands of affective-emotional order related to gender inequities, with an overload of domestic work and family care. The health team constitutes a support point and offers welcoming and sensitive listening. Conclusion and implications for practice affective deprivation and wear and tear due to domestic and family functions and the relationship with the partner mark women's demands for care. Professionals perform practices from the perspective of integrality, but there are institutional and team limits in dealing with singularities. Overcoming these limitations requires opening paths to the empowerment of women, which does not portray the problematized reality, and support professionals in meeting the principle of integrality in the context of women in social and economic vulnerabilities.

Testes morphology and the identification of transcripts of the hormonal pathways of the velvetbean caterpillar Anticarsia gemmatalis Hübner, 1818 (Lepidoptera: Erebidae).

Anticarsia gemmatalis is one of the main defoliating pests of soybeans in Brazil. In the current study, we characterized the histomorphology of the testes and the spermatogenesis process in A. gemmatalis. We also identified transcripts involved in the biosynthesis, metabolism, and signaling of juvenile and ecdysteroid hormones, in order to provide information about potential mechanisms of regulation of hormonal pathways in this species. Our analyses revealed that the A. gemmatalis larvae have a pair of kidney-shaped testicles. These are divided into four testicular follicles, where there are germ cell cysts at different stages of development. In the pupal stage, the testicles are fused, so adults have a single spherical testis, with a variable number of follicles. The A. gemmatalis has centripetal spermatogenesis and exhibits spermatic dimorphism. We identified 31 transcripts that encode proteins involved in juvenile hormone and ecdysteroid pathways, such as mevalonate kinase, CYP14A1, ecdysone receptor, among others. Our results on the morphology of the testes and spermatogenesis process, as well as identification of the genes involved in hormonal pathways in A. gemmatalis, provide important data for understanding the biology of this agricultural pest, which can be used as a basis for further research in other economically important lepidopterans.

Funcionalidade de uma criança com paralisia cerebral bilateral submetida a cirurgia multinível: relato de caso / Functioning of a child with bilateral cerebral palsy submitted to multilevel surgery: case report

INTRODUÇÃO: Intervenções em diferentes articulações podem ser necessárias para corrigir a marcha agachada e outras alterações musculoesqueléticas que ocorrem com o passar do tempo em crianças com Paralisia Cerebral (PC). A cirurgia multinível reduz o número de hospitalizações, contribui para a prevenção de deficiências secundárias e melhora a capacidade de locomoção de crianças com diplegia. OBJETIVO: Documentar as mudanças na mobilidade de uma criança com PC bilateral, do tipo diplégica, após cirurgia multinível de membros inferiores na realidade brasileira. MATERIAIS E MÉTODOS: A participante foi uma menina de 8 anos, Gross Motor Function Classification System nível III. A mãe assinou o termo de consentimento livre e esclarecido. O Gross Motor Function Measure-66 (GMFM-66) foi realizado um dia antes da cirurgia e um, três, seis e doze meses após a cirurgia. Para completar os registros da evolução da criança, foram obtidas informações adicionais por meio do sistema eletrônico do hospital. RESULTADOS: O escore total do GMFM-66 foi: 49,6 pré-operatório (IC95%: 47,3- 51,9); 42,8 após um mês (IC95%: 40,7-45,0); 49,9 após três meses (IC95%: 47,6-52,1); 52,6 após seis meses (IC95%: 50,2-55,0) e 56,9 após um ano (IC95%: 54,6-59,2), aumentando após seis meses da cirurgia (*p<0,05). A participante apresentou adesão satisfatória à fisioterapia. CONCLUSÃO: Estudo de caso de criança brasileira com PC, usando o sistema único de saúde. O impacto da cirurgia multinível foi predominante na mobilidade, com piora da capacidade logo após a cirurgia e melhora progressiva ao longo dos meses. Os fatores que podem ter contribuído para nossos resultados foram adesão, frequência, fatores contextuais.

INTRODUCTION: Interventions in different joints may be necessary to correct crouch gait and other musculoskeletal changes that occur as time passes for Cerebral Palsy (CP) children. Multilevel surgery reduces the number of hospitalizations, contributes to the prevention of secondary disabilities, and improves the ambulation ability of children with diplegia. OBJECTIVE: Document the changes in mobility outcomes of a bilateral CP child, type diplegia, child after lower limbs multilevel surgery in the Brazilian context. MATERIAL AND METHODS: The participant was an eight-year-old girl, Gross Motor Function Classification System level III. The mother signed the informed consent form. The Gross Motor Function Measure­66 (GMFM-66) was performed one day before surgery and one, three, six, and twelve months after surgery. Additional information was obtained through the electronic system of the hospital to complete the child's evolution records. RESULTS: The GMFM-66 total score was: 49.6 pre-operative (CI95%: 47.3-51.9); 42.8 after one month (CI95%: 40.7-45.0); 49.9 after three months (CI95%: 47.6-52.1); 52.6 after six months (CI95%: 50.2-55.0) and 56.9 after one year (CI95%: 54.6-59.2), increasing after 6 months of surgery (*p<0.05). The participant presented satisfactory adherence to physiotherapy. CONCLUSION: This study describes the case of a Brazilian child with CP using the public health system. The impact of multilevel surgery was predominant in mobility, with worsening of capacity soon after surgery and progressive improvement over the months. Factors that may have contributed to our results were adherence, frequency, contextual factors.

3D Scaffolds to Model the Hematopoietic Stem Cell Niche: Applications and Perspectives.

Hematopoietic stem cells (HSC) are responsible for the production of blood and immune cells during life. HSC fate decisions are dependent on signals from specialized microenvironments in the bone marrow, termed niches. The HSC niche is a tridimensional environment that comprises cellular, chemical, and physical elements. Introductorily, we will revise the current knowledge of some relevant elements of the niche. Despite the importance of the niche in HSC function, most experimental approaches to study human HSCs use bidimensional models. Probably, this contributes to the failure in translating many in vitro findings into a clinical setting. Recreating the complexity of the bone marrow microenvironment in vitro would provide a powerful tool to achieve in vitro production of HSCs for transplantation, develop more effective therapies for hematologic malignancies and provide deeper insight into the HSC niche. We previously demonstrated that an optimized decellularization method can preserve with striking detail the ECM architecture of the bone marrow niche and support HSC culture. We will discuss the potential of this decellularized scaffold as HSC niche model. Besides decellularized scaffolds, several other methods have been reported to mimic some characteristics of the HSC niche. In this review, we will examine these models and their applications, advantages, and limitations.

Cognitive dysfunction and serum levels of brain-derived neurotrophic factor (BDNF) in primary anti-phospholipid syndrome (PAPS).

OBJECTIVES: Cognitive dysfunction (CD) is a poorly understood non-stroke central neurological manifestation in anti-phospholipid syndrome (APS). Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in neural plasticity and could potentially be a biomarker of CD in primary APS (PAPS). The aim of the study is to assess CD in PAPS patients and to evaluate its association with clinical data, anti-phospholipid antibodies and serum BDNF levels. METHODS: This cross-sectional study compared 44 PAPS patients and 20 healthy controls matched for age, gender and education. PAPS patients and controls underwent a standardized cognitive examination. The demographic, clinical and laboratory characteristics of patients were recorded. Serum BDNF was measured by Enzyme Linked Immunosorbent. RESULTS: Fourteen (31.8%) of the 44 patients with PAPS had CD compared with only one (5%) healthy control (P =0.019). PAPS patients presented lower serum BDNF levels when compared with controls (P =0.007). Lower levels of BDNF were associated with CD in PAPS patients (P =0.032). In the univariate analysis, a positive association was found between CD and livedo reticularis, deep vein thrombosis, stroke, seizure, smoking as well as a negative association with Mini Mental State Examination and serum BDNF. According to multivariate analysis, the only independent predictor of CD in PAPS was stroke (OR 137.06; 95% CI: 4.73, 3974.32; P =0.004). CONCLUSIONS: CD is commonly reported in PAPS patients; however, its assessment lacks in standards and objective screening tests. The association between CD and low serum BDNF suggests that this neurotrophin can be a promising biomarker for PAPS cognitive impairment.

Genetic study in Aedes (Stegomyia) aegypti (Linnaeus, 1762) from Londrina (Paraná State, Brazil): an approach to population structure and pyrethroid resistance

Abstract Londrina is the fourth most populous city in southern Brazil. Its subtropical weather with rain in all seasons, as well as its high population density, make the city perfect for the Aedes aegypti (Linnaeus, 1762) life cycle. Over the last few years, Londrina presented high infestation indexes and was one of the cities with the most reported cases of dengue. Uncontrolled use of synthetic insecticides may influence the mosquito's genetic composition. In this paper, we studied mitochondrial DNA and kdr mutations in Aedes aegypti. The analysis of the ND4 gene in 330 specimens showed the presence of 27 haplotypes. The pyrethroid resistance alleles (kdr) evaluated are present in the collected populations, with a 50% frequency of the Val1016Ile and 48% of the Phe1534Cys mutations. Such analysis of the mutations in the populations collected at the State University of Londrina's campus - a microenvironment that differs from the rest of the city - showed frequencies of 57% and 62%, respectively. The low gene flow observed, Nm = 0.11 and Nm = 0.10, along with the elevated differentiation, Fst = 0.19 and Fst = 0.18, among populations suggest an influence of genetic drift. The strong presence of resistance alleles kdr in the city is evident, which demonstrates that even with the interruption of the use of pyrethroids by the National Dengue Control Program, resistance may be maintained due to domestic use. Thus, the results have shown the need for genetic monitoring, alongside other entomological surveillance monitoring tools, to create strategies of mosquito control.

Saúde de mulheres de dois grupos de atividade física: estudo de acompanhamento durante a COVID-19 / Health of women from two physical activity programs: a follow-up study during the COVID-19

O objetivo foi monitorar indicadores de saúde mental e a prática de exercícios de respiração e alongamento no contexto doméstico durante dois meses da pandemia COVID-19 entre mulheres participantes de dois grupos de atividade física de Unidades Básicas de Saúde. A amostra foi composta por 17 mulheres, que participaram de quatro contatos telefônicos. As variáveis foram a autopercepção de saúde, da ansiedade, da qualidade do sono e da concentração, além de dificuldades econômicas (falta do básico em casa no período) e a prática de exercícios de respiração e alongamento no domicílio, bem como as dificuldades para a realização destas. O teste de Friedman foi utilizado para verificar diferenças nas variáveis nos quatro momentos. Diferenças significativas na autopercepção da qualidade do sono (com piores resultados em T4) e na prática de exercícios (piores resultados em T1) foram observadas. Em três dos quatro momentos do monitoramento, pelo menos uma mulher referiu que havia faltado o básico para a sobrevivência. Onze mulheres citaram barreira(s) em pelo menos um dos momentos do estudo para a realização dos exercícios, sendo a mais citada: não saber realizar o exercício ou se sentir insegura realizando sozinha. Conclui-se que, considerando a necessidade de adequação dos serviços de saúde em função da pandemia, ações de monitoramento, combinadas com estratégias de escuta e aconselhamento, podem ser uma boa alternativa para o acompanhamento da saúde dos participantes dos grupos de atividade física

The objective was to monitor mental health indicators and the practice of breathing and stretching exercises in the domestic context during two months of the COVID-19 pandemic among women who were enrolled in two physical activity groups in Primary Health Care. The sample included 17 women, who participated in all telephone contacts at four moments. The variables were self-perceived health, anxiety, quality of sleep and concentration, in addition to economic difficulties (lack of basics at home in the period), breathing and stretching exercises at home, and possible barriers to performing these exercises. The Friedman test was used to verify differences in the variables at the four moments. Significant differences in self-perception of sleep quality (with worst results in T4) and in the practice of exercises (worst results in T1) were observed. In three of the four moments of monitoring, at least one woman reported that she lacked the basics for survival. Eleven women mentioned barriers in at least one of the moments of the study to perform the exercises, being not knowing how to perform the exercise or feeling insecure performing the most mentioned barrier. Considering the need to adapt health services to the pandemic, monitoring actions, combined with listening and counseling strategies, can be a good alternative for monitoring the health of participants in physical activity groups

Late-onset hereditary ATTR V30M amyloidosis with polyneuropathy: Characterization of Brazilian subjects from the THAOS registry.

BACKGROUND: Despite growing numbers of patients diagnosed with late-onset hereditary ATTR V30M amyloidosis with polyneuropathy (ATTRv-PN), this condition remains poorly characterized in Brazil. OBJECTIVE: Characterize late-onset V30M ATTRv-PN in Brazil. MATERIAL AND METHODS: Demographic and clinical data at the time of enrolment for Brazilian subjects with symptomatic V30M ATTRv-PN were extracted from the ongoing, multinational, longitudinal, observational Transthyretin Amyloidosis Outcomes Survey (THAOS; cut-off date: January 30, 2017). Subjects were divided into those with symptom onset at age <50 years (EO-V30M), and at age ≥50 years (LO-V30M). RESULTS: A total of 96 Val30Met patients were symptomatic. LO-V30M (n = 25, 26.0%) had a longer time to diagnosis (mean 5.1 vs. 2.8 yrs.; p = 0.006) and less frequently positive family history (40% vs. 95.8%; p < 0.0001) than EO-V30M. Clinically, subjects with LO-V30M had more imbalance (92% vs. 54.9%; p = 0.006), deep sensory loss (100% vs. 80%; p = 0.0178), electrocardiogram abnormalities (88.9% vs. 59.4; p = 0.0241), and interventricular septum hypertrophy (69.2% vs. 0%; p < 0001) and less frequently sensory dissociation (12% vs. 74%; p < 0.0001). Also, LO-V30M tended to have more severe mean Neurologic Composite Score (101 vs. 70 pts.; p = 0.1136). CONCLUSIONS: LO-V30M ATTRv-PN is not unusual in Brazil, tending to be more difficult to diagnose and present with a more severe phenotype, with more large nerve fibers and cardiac involvement than EO-V30M. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00628745.

Characterization of a novel decellularized bone marrow scaffold as an inductive environment for hematopoietic stem cells.

Due to the increasing demand for a bone marrow study model, we developed a natural scaffold from decellularized bovine bone marrow (DeBM). The obtained bioscaffold was analyzed after the decellularization process; histological staining, scanning and transmission electron microscopy confirmed the preservation of its native 3D-architecture; including blood vessels and cell niches as well as the integrity of important components of the extracellular matrix; Collagen III, IV and fibronectin. In addition to biochemical composition, physical properties of the bone marrow were also conserved. We evaluated the suitability of this bio-scaffold as a tridimensional culture platform. Seeding experiments with umbilical cord-derived hematopoietic stem cells and human bone marrow stromal cell line HS5 demonstrated that this scaffold is capable of supporting hematopoietic and stromal cell adhesion and proliferation without the need of exogenous factors. DeBM provided an inductive environment for the repopulation of the bone marrow inducing the expression of SDF-1, HGF and SCF by seeded stromal cells. The presence of these potent hematopoietic chemoattractants would be crucial for ex vivo long-term culture of HSCs, and for recreating the natural microenvironment of the bone marrow for bioengineering applications. We conclude that the decellularization process succeeded in preserving the 3D structure and mechanical properties of the bone marrow. The resulting scaffold is suitable for cell culture, representing an advantageous bone marrow experimental model, and potentially an effective platform for CD34+ HSC expansion and differentiation for clinical applications.

The Impact of Systemic Lupus Erythematosus on the Clinical Phenotype of Antiphospholipid Antibody-Positive Patients: Results From the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Clinical Database and Repository.

OBJECTIVE: Although systemic lupus erythematosus (SLE) is the most common autoimmune disease associated with antiphospholipid antibodies (aPL), limited data exist regarding the impact of SLE on the clinical phenotype of aPL-positive patients. The primary objective of this study was to compare the clinical, laboratory, and treatment characteristics of aPL-positive patients with SLE with those of aPL-positive patients without SLE. METHODS: A secure web-based data capture system was used to store patient demographic characteristics and aPL-related clinical and laboratory characteristics. Inclusion criteria included positive aPL according to the updated Sapporo classification criteria. Antiphospholipid antibody-positive patients fulfilling the American College of Rheumatology criteria for the classification of SLE ("aPL with SLE") and those with no other autoimmune diseases ("aPL only") were included in the analysis. RESULTS: Six hundred seventy-two aPL-positive patients were recruited from 24 international centers; 426 of these patients did not have other autoimmune disease, and 197 had SLE. The frequency of thrombocytopenia, hemolytic anemia, low complement levels, and IgA anti-ß2 -glycoprotein I (anti-ß2 GPI) antibodies was higher in the aPL-positive patients with SLE, whereas the frequency of cognitive dysfunction and IgG anti-ß2 GPI antibodies was higher in the aPL-only group. The frequency of arterial and venous thromboses (including recurrent) as well as pregnancy morbidity was similar in the 2 groups. The prevalence of cardiovascular disease risk factors at the time of entry into the registry entry did not differ between the 2 groups, with the exception of current smoking, which was more frequent in aPL-positive patients with SLE. CONCLUSION: Although the frequencies of thrombosis and pregnancy morbidity are similar in aPL-positive patients with and those without SLE, the diagnosis of SLE in patients with persistently positive aPL is associated with an increased frequency of thrombocytopenia, hemolytic anemia, low complement levels, and positive IgA anti-ß2 GPI antibodies.

Up-regulation of SPINT2/HAI-2 by Azacytidine in bone marrow mesenchymal stromal cells affects leukemic stem cell survival and adhesion.

The role of tumour microenvironment in neoplasm initiation and malignant evolution has been increasingly recognized. However, the bone marrow mesenchymal stromal cell (BMMSC) contribution to disease progression remains poorly explored. We previously reported that the expression of serine protease inhibitor kunitz-type2 (SPINT2/HAI-2), an inhibitor of hepatocyte growth factor (HGF) activation, is significantly lower in BMMSC from myelodysplastic syndromes (MDS) patients compared to healthy donors (HD). Thus, to investigate whether this loss of expression was due to SPINT2/HAI-2 methylation, BMMSC from MDS and de novo acute myeloid leukaemia (de novo AML) patients were treated with 5-Azacitidine (Aza), a DNA methyltransferase inhibitor. In MDS- and de novo AML-BMMSC, Aza treatment resulted in a pronounced SPINT2/HAI-2 levels up-regulation. Moreover, Aza treatment of HD-BMMSC did not improve SPINT2/HAI-2 levels. To understand the role of SPINT2/HAI-2 down-regulation in BMMSC physiology, SPINT2/HAI-2 expression was inhibited by lentivirus. SPINT2 underexpression resulted in an increased production of HGF by HS-5 stromal cells and improved survival of CD34+ de novo AML cells. We also observed an increased adhesion of de novo AML hematopoietic cells to SPINT2/HAI-2 silenced cells. Interestingly, BMMSC isolated from MDS and de novo AML patients had increased expression of the integrins CD49b, CD49d, and CD49e. Thus, SPINT2/HAI-2 may contribute to functional and morphological abnormalities of the microenvironment niche and to stem/progenitor cancer cell progression. Hence, down-regulation in SPINT2/HAI-2 gene expression, due to methylation in MDS-BMMSC and de novo AML-BMMSC, provides novel insights into the pathogenic role of the leukemic bone marrow microenvironment.

Hematopoietic cell kinase (HCK) is a potential therapeutic target for dysplastic and leukemic cells due to integration of erythropoietin/PI3K pathway and regulation of erythropoiesis: HCK in erythropoietin/PI3K pathway.

New drug development for neoplasm treatment is nowadays based on molecular targets that participate in the disease pathogenesis and tumor phenotype. Herein, we describe a new specific pharmacological hematopoietic cell kinase (HCK) inhibitor (iHCK-37) that was able to reduce PI3K/AKT and MAPK/ERK pathways activation after erythropoietin induction in cells with high HCK expression: iHCK-37 treatment increased leukemic cells death and, very importantly, did not affect normal hematopoietic stem cells. We also present evidence that HCK, one of Src kinase family (SFK) member, regulates early-stage erythroid cell differentiation by acting as an upstream target of a frequently deregulated pathway in hematologic neoplasms, PI3K/AKT and MAPK/ERK. Notably, HCK levels were highly increased in stem cells from patients with some diseases, as Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML), that are associated with ineffective erythropoiesis These discoveries support the exploration of the new pharmacological iHCK-37 in future preclinical and clinical studies.

Segurança do paciente na práxis do cuidado de enfermagem: percepção de enfermeiros / Patient safety in the practice of nursing care: nurses' perceptions / Seguridad del paciente en la práctica de enfermería: percepciones de enfermeras

São considerados princípios que qualificam o cuidado de enfermagem e direciona a prática baseada em evidência, com ética e compromisso profissional, a realização de procedimentos seguros e adequados aos pacientes. Objetivo: Identificar a percepção dos enfermeiros sobre a segurança do paciente na práxis do cuidado de enfermagem. Método: Pesquisa descritiva, exploratória de caráter qualitativo, realizada com nove enfermeiros de um hospital de pequeno porte, localizado na região central do Rio Grande do Sul. Os dados foram coletados no período de agosto a novembro do ano de 2011 por meio de entrevista semi-estruturada e foram submetidos à análise de conteúdo. Resultados: Emergiram quatro categorias: Segurança do Paciente: visibilidade na organização do cuidado de enfermagem; Segurança do Paciente: um devir a ser construído no cuidado de enfermagem; Desorganização do ambiente e do profissional: fatores que contribuem para o erro; Diferentes posturas do enfermeiro frente a situação do erro. Conclusões: A segurança do paciente poderá ser efetivada a partir do conhecimento, compromisso e participação de todos os profissionais, sendo necessário desenvolver um movimento cultural e transformador na práxis do cuidado de enfermagem.

Ethical and professional commitment and the application of safe and adequate procedures to patients are considered principles guiding nursing care provision and evidence-based practice. This study aims, therefore, to identify the perceptions of nurses about patient safety in the practice of nursing care. Method: Descriptive, qualitative, exploratory study conducted with nine nurses at a small hospital located in the central region of the State of Rio Grande do Sul, Brazil. The data were collected from August to November 2011 using semi-structured interviews and were subjected then to content analysis. Results: Four categories emerged: Patient Safety: visibility in the organization of nursing care; Patient Safety: transformation based on nursing care; Disorganization of working and professional environment: factors contributing to errors; Different attitudes towards errors. Conclusion: Patient safety is achieved through the knowledge, commitment and participation of all professionals contributing to create a cultural change and transformative practice of nursing care.

Son considerados principios que cualifican los cuidados de enfermería y dirigen la práctica basada en la evidencia, el compromiso ético y profesional, la realización de procedimientos seguros y adecuados para los pacientes. Objetivo: Identificar las percepciones de las enfermeras acerca de la seguridad del paciente en la práctica de los cuidados de enfermería. Método: Investigación cualitativa, descriptiva exploratoria, realizada con nueve enfermeras en un pequeño hospital, ubicado en la región central de Río Grande do Sul. Los datos fueron recolectados entre agosto y noviembre de 2011 a través de entrevista semiestructurada y fueron sometidos a análisis de contenido. Resultados: Cuatro categorías emergieron: Seguridad del Paciente: visibilidad en la organización de los cuidados de enfermería; Seguridad del Paciente: un devenir que se construye en los cuidados de enfermería; Desorganización del medio ambiente y profesional: factores que contribuyen al error; Diferentes posturas de la enfermera en el estado de error. Conclusiones: La seguridad del paciente se puede hacer a partir del conocimiento, el compromiso y la participación de todos los profesionales, siendo necesario desarrollar un movimiento cultural y praxis transformadora de la atención de enfermería.

Comparative cytogenetics between two species of the family Pseudopimelodidae (Siluriformes): occurrence of natural triploidy and supernumerary chromosomes.

The Pseudopimelodidae family comprises 35 species however, cytogenetic studies have been performed in only six species. This study uncovered karyotypic data on Pseudopimelodus pulcher and Microglanis cottoides. Both species possessed 2n = 54, with 20m + 16sm + 10st + 8a and FN = 100 for P. pulcher and 30m + 14sm + 6st + 4a and FN = 104 for M. cottoides. A female of M. cottoides with 45m + 21sm + 9st + 6a (2n = 81) plus two extra small chromosomes was found, indicating a natural triploidy with supernumerary chromosomes. The formation of the polyploid individual seems to have come from a diploid female gamete, due to the presence of a marker chromosome pair partially heterochromatic presents only in females and common to that exemplar. This triploid female showed three chromosomes with nitrate staining (AgNOR), 18S rDNA probe and chromomycin A3 (CMA3) staining. AgNORs were observed on pairs 12 and 23 in P. pulcher and pair 24 in M. cottoides, results that were confirmed with an 18S rDNA probe and CMA3 fluorochrome. These are the first chromosomal data for P. pulcher and provide the first description of natural triploidy with the presence of supernumerary chromosomes in this family and emphasizing well the chromosomal rearrangements diversification between this species.

Growth factor stimulation improves the structure and properties of scaffold-free engineered auricular cartilage constructs.

The reconstruction of the external ear to correct congenital deformities or repair following trauma remains a significant challenge in reconstructive surgery. Previously, we have developed a novel approach to create scaffold-free, tissue engineering elastic cartilage constructs directly from a small population of donor cells. Although the developed constructs appeared to adopt the structural appearance of native auricular cartilage, the constructs displayed limited expression and poor localization of elastin. In the present study, the effect of growth factor supplementation (insulin, IGF-1, or TGF-ß1) was investigated to stimulate elastogenesis as well as to improve overall tissue formation. Using rabbit auricular chondrocytes, bioreactor-cultivated constructs supplemented with either insulin or IGF-1 displayed increased deposition of cartilaginous ECM, improved mechanical properties, and thicknesses comparable to native auricular cartilage after 4 weeks of growth. Similarly, growth factor supplementation resulted in increased expression and improved localization of elastin, primarily restricted within the cartilaginous region of the tissue construct. Additional studies were conducted to determine whether scaffold-free engineered auricular cartilage constructs could be developed in the 3D shape of the external ear. Isolated auricular chondrocytes were grown in rapid-prototyped tissue culture molds with additional insulin or IGF-1 supplementation during bioreactor cultivation. Using this approach, the developed tissue constructs were flexible and had a 3D shape in very good agreement to the culture mold (average error <400 µm). While scaffold-free, engineered auricular cartilage constructs can be created with both the appropriate tissue structure and 3D shape of the external ear, future studies will be aimed assessing potential changes in construct shape and properties after subcutaneous implantation.

Development of scaffold-free elastic cartilaginous constructs with structural similarities to auricular cartilage.

External ear reconstruction with autologous cartilage still remains one of the most difficult problems in the fields of plastic and reconstructive surgery. As the absence of tissue vascularization limits the ability to stimulate new tissue growth, relatively few surgical approaches are currently available (alloplastic implants or sculpted autologous cartilage grafts) to repair or reconstruct the auricle (or pinna) as a result of traumatic loss or congenital absence (e.g., microtia). Alternatively, tissue engineering can offer the potential to grow autogenous cartilage suitable for implantation. While tissue-engineered auricle cartilage constructs can be created, a substantial number of cells are required to generate sufficient quantities of tissue for reconstruction. Similarly, as routine cell expansion can elicit negative effects on chondrocyte function, we have developed an approach to generate large-sized engineered auricle constructs (≥3 cm(2)) directly from a small population of donor cells (20,000-40,000 cells/construct). Using rabbit donor cells, the developed bioreactor-cultivated constructs adopted structural-like characteristics similar to native auricular cartilage, including the development of distinct cartilaginous and perichondrium-like regions. Both alterations in media composition and seeding density had profound effects on the formation of engineered elastic tissue constructs in terms of cellularity, extracellular matrix accumulation, and tissue structure. Higher seeding densities and media containing sodium bicarbonate produced tissue constructs that were closer to the native tissue in terms of structure and composition. Future studies will be aimed at improving the accumulation of specific tissue constituents and determining the clinical effectiveness of this approach using a reconstructive animal model.