Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle-income setting: A randomized controlled trial protocol.

Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews.

BACKGROUND: To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS: Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION: Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.

Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors.

BACKGROUND: Andexanet alfa is a modified recombinant inactive form of human factor Xa developed for reversal of factor Xa inhibitors. METHODS: We evaluated 352 patients who had acute major bleeding within 18 hours after administration of a factor Xa inhibitor. The patients received a bolus of andexanet, followed by a 2-hour infusion. The coprimary outcomes were the percent change in anti-factor Xa activity after andexanet treatment and the percentage of patients with excellent or good hemostatic efficacy at 12 hours after the end of the infusion, with hemostatic efficacy adjudicated on the basis of prespecified criteria. Efficacy was assessed in the subgroup of patients with confirmed major bleeding and baseline anti-factor Xa activity of at least 75 ng per milliliter (or ≥0.25 IU per milliliter for those receiving enoxaparin). RESULTS: Patients had a mean age of 77 years, and most had substantial cardiovascular disease. Bleeding was predominantly intracranial (in 227 patients [64%]) or gastrointestinal (in 90 patients [26%]). In patients who had received apixaban, the median anti-factor Xa activity decreased from 149.7 ng per milliliter at baseline to 11.1 ng per milliliter after the andexanet bolus (92% reduction; 95% confidence interval [CI], 91 to 93); in patients who had received rivaroxaban, the median value decreased from 211.8 ng per milliliter to 14.2 ng per milliliter (92% reduction; 95% CI, 88 to 94). Excellent or good hemostasis occurred in 204 of 249 patients (82%) who could be evaluated. Within 30 days, death occurred in 49 patients (14%) and a thrombotic event in 34 (10%). Reduction in anti-factor Xa activity was not predictive of hemostatic efficacy overall but was modestly predictive in patients with intracranial hemorrhage. CONCLUSIONS: In patients with acute major bleeding associated with the use of a factor Xa inhibitor, treatment with andexanet markedly reduced anti-factor Xa activity, and 82% of patients had excellent or good hemostatic efficacy at 12 hours, as adjudicated according to prespecified criteria. (Funded by Portola Pharmaceuticals; ANNEXA-4 ClinicalTrials.gov number, NCT02329327.).

Knockdown of OsNRT2.4 modulates root morphology and alters nitrogen metabolism in response to low nitrate availability in rice.

The expression patterns of the NRT2 genes have been well described; however, the role of OsNRT2.4 in root growth is not well known. In this study, we thus aimed at investigating the role of high-affinity NO3- transport OsNRT2.4 in root growth modulation. Through the amiRNA-mediated gene silencing technique, we successfully obtained osnrt2.4 knockdown lines to study the role of OsNRT2.4 on root growth under low nitrate conditions. We performed real-time PCR analysis to investigate the relative gene expression level in root and shoot, soluble metabolites, and measurement of root system. Knockdown of OsNRT2.4 decreased rice growth. The comparison with wild-type (WT) plants showed that (i) knockdown of OsNRT2.4 inhibited root formation under low NO3- supply; (ii) we demonstrated that the mutant lines had significantly increased NO3- uptake than WT plants when grown in different nitrate supplies; (iii) osnrt2.4 knockdown lines showed an alteration in nitrogen metabolism, and this affected the root growth; and (iv) the downregulation of OsNRT2.4 enhanced the expression of gene response of low external NO3- concentrations. Herein we provide new insights in OsNRT2.4 functions. Our data demonstrated that OsNRT2.4 plays a role in root growth, nitrogen metabolic pathway and probably have functions in nitrate transport from root to shoot under low nitrate availability in rice. Supplementary Information: The online version contains supplementary material available at 10.1007/s11032-021-01273-6.

Identification of genes from the general phenylpropanoid and monolignol-specific metabolism in two sugarcane lignin-contrasting genotypes.

The phenylpropanoid pathway is an important route of secondary metabolism involved in the synthesis of different phenolic compounds such as phenylpropenes, anthocyanins, stilbenoids, flavonoids, and monolignols. The flux toward monolignol biosynthesis through the phenylpropanoid pathway is controlled by specific genes from at least ten families. Lignin polymer is one of the major components of the plant cell wall and is mainly responsible for recalcitrance to saccharification in ethanol production from lignocellulosic biomass. Here, we identified and characterized sugarcane candidate genes from the general phenylpropanoid and monolignol-specific metabolism through a search of the sugarcane EST databases, phylogenetic analysis, a search for conserved amino acid residues important for enzymatic function, and analysis of expression patterns during culm development in two lignin-contrasting genotypes. Of these genes, 15 were cloned and, when available, their loci were identified using the recently released sugarcane genomes from Saccharum hybrid R570 and Saccharum spontaneum cultivars. Our analysis points out that ShPAL1, ShPAL2, ShC4H4, Sh4CL1, ShHCT1, ShC3H1, ShC3H2, ShCCoAOMT1, ShCOMT1, ShF5H1, ShCCR1, ShCAD2, and ShCAD7 are strong candidates to be bona fide lignin biosynthesis genes. Together, the results provide information about the candidate genes involved in monolignol biosynthesis in sugarcane and may provide useful information for further molecular genetic studies in sugarcane.

Productive, metabolic and anatomical parameters of menthol mint are influenced by light intensity.

The cultivation of aromatic species to obtain essential oils has great economic importance, presenting an increasing demand from different industrial sectors, especially to menthol mint (Mentha arvensis L.) essential oil, rich in menthol (70-80%). Consortium cultivation has been an important practice in agricultural systems whose land use is necessary, consequently promoting strong competition for light in reduced space. Thus, this study aimed verifying if different light intensities might promote chemical, metabolical and anatomical alterations in menthol mint. Plants were grown in greenhouse at different average of light intensities (137, 254, 406 and 543 µmol photons m2 s1). Samples were collected 43 days after germination and submitted to following analyses: Gravimetric test, photosynthetic pigments, soluble fractions, enzymatic activity, N-total, trichome density and histochemistry and chemometric test based on essential oil chemical profile. Fresh mass gain, trichome density, essential oil content and soluble sugars were positively influenced by light intensity increase. On the other hand, total-N, NO3--N and pigments content have decreased influenced by light intensity increase. In the secretion from the trichomes, phenolic substances were reported, as well as lipophilic ones in the peltate ones. The increase of oxygenated monoterpenes was favored by light intensity decrease.

A 3 months clinical evaluation comparing two professional bleaching systems of 25% and 40% hydrogen peroxide and extended treatment outcome using a power versus a manual toothbrush.

OBJECTIVES: To assess two professional tooth bleaching products: Philips Zoom WhiteSpeed (PZW) and Ultradent Opalescence Boost PF (UOB); and to assess bleaching maintenance after use of Philips Sonicare power toothbrush (SDC) or manual toothbrush (MTB). METHODS: There was a randomized, parallel clinical trial. Eligible subjects were 18-75 years, with VITA Classical shade (VCS) of A3 on anterior teeth. Subjects were randomized to bleaching with PZW or UOB. Tooth color and shade were assessed using VITA EasyShade (VES), VCS, and VITA Bleachedguide (VBG). Subjects returned on Days 7 and 30. On Day 30, participants were dispensed either SDC or MTB for home use until Day 90. RESULTS: A total of 135 subjects completed the study. For the primary endpoint, ΔE at Day 7, a significantly larger reduction was observed for PZW than UOB (P value = .0059). Significant differences in shade were also observed at Day 7 for VCS (P value = 0.0106), and VBG (P value = .0489). On Day 90, the SDC was statistically superior to MTB in maintaining shade per VBG and VCS, but not ΔE. CONCLUSIONS: At Day 7, PZW showed statistically greater change in overall color and shade than UOB. The SDC maintained tooth shade significantly better than MTB. Both bleaching regimens were safe. CLINICAL SIGNIFICANCE: The outcomes confirm the bleaching efficacy advantage of a lower H2 O2 dose-LED accelerated professional tooth bleaching system, compared to a higher-dose H2 O2 approach. The safety assessments via clinical intraoral exam and daily logged use of subjects' desensitizing agents, and the incidence and severity of reported sensitivity, provide evidence that both professional products are safe for use. Finally, powered tooth brushing may confer an advantage to manual tooth brushing in maintaining tooth shade-change results following professional whitening.

Validation of parameters to fill in the Perroca's patient classification system. / Validação de parâmetros para preenchimento do sistema de classificação de pacientes de Perroca.

OBJECTIVE: To propose parameters to qualify the filling of the Patient Classification System proposed by Perroca. METHOD: Validation study by consensus held in 2014, in a university hospital. The sample included 10 specialist nurses, four teachers and a computer science professional, all knowledgeable in the Classification System. The information was collected and analyzed through meetings registration, where strategies were discussed to enable the systematic application of the instrument in the institution. For the construction, it was considered a consensus of 100% among the experts. RESULTS: The computerized parameter guide was elaborated with a description of what to evaluate in each item of the Perroca's instrument, standardizing the filling by the nurses. CONCLUSIONS: The parameter guide made it possible to minimize the subjectivity of the evaluators when applying the classification instrument, provided guiding elements to fill it in and qualified the nursing care benchmarking.

An Evaluation of Plaque and Gingivitis Reduction Following Home Use of Sonicare FlexCare Platinum with Premium Plaque Control Brush Head and a Manual Toothbrush.

OBJECTIVES: To assess the effect of the Philips Sonicare FlexCare Platinum with Premium plaque control brush head on gingival inflammation, bleeding, and supragingival plaque reduction following a six-week period of home use compared to a manual toothbrush. METHODS: This was a randomized, single-blind, parallel-design clinical trial. Subjects included in the study were routine manual toothbrush users who were generally healthy non-smokers, aged 18-65 years, with mild to moderate gingivitis. Subjects with advanced periodontal disease, excessive gingival recession, and heavy deposits of calculus or rampant decay were excluded from the study. Eligible participants were dispensed either Philips Sonicare FlexCare Platinum with Premium plaque control brush head (PC), or an ADA Reference manual toothbrush (MTB) for twice-daily home oral hygiene procedures for six weeks. Efficacy measures included the Lobene and Soparker Modification of Quigley and Hein Plaque Index (MPI), the Modified Gingival Index (MGI), and Gingival Bleeding Index (GBI). Safety was evaluated by oral examination and subject report. Efficacy and safety were assessed at Baseline, and at two and six weeks following product home use. RESULTS: Of 154 subjects randomized, 143 subjects completed the study. For the primary endpoint, MGI at Week 2, statistically significantly larger reductions in MGI were observed for PC versus MTB, p < 0.0001. The adjusted mean reduction and standard error estimates (SE) for MGI, expressed as percent reduction versus Baseline to Week 2, were 41.73% (2.00%) for PC and 7.38% (2.02%) for MTB. Statistically significant differences were also observed for MPI and GBI at Week 2, and for all metrics at Week 6. CONCLUSIONS: Philips Sonicare FlexCare Platinum with Premium plaque control brush head statistically significantly reduces gingival inflammation, gingival bleeding, and plaque following two and six weeks of home use, compared to manual tooth brushing alone.

A Comparison of the Effect of Two Power Toothbrushes on the Gingival Health and Plaque Status of Subjects with Moderate Gingivitis.

OBJECTIVES: To compare the effect of the Philips Sonicare DiamondClean plus Premium plaque control brush head with the Oral-B 7000 plus CrossAction brush head on gingivitis and supragingival plaque reduction following a 42-day period of home use. METHODS: This was a randomized, parallel, examiner-blind, prospective clinical trial conducted on generally healthy subjects. Eligible subjects met the following eligibility criteria: age 18-65, non-smoker, routine manual toothbrush user, ≥ 50 sites of gingival bleeding per the Gingival Bleeding Index (GBI), and ≥ 1.8 plaque score per the Modified Plaque Index (MPI), assessed three to six hours following the last oral hygiene procedure. Eligible subjects were enrolled in the study and randomly assigned to use either a Philips Sonicare DiamondClean with Premium plaque control brush head power toothbrush (SPC) or an Oral-B® 7000 with CrossAction™ brush head power toothbrush (OCA), for twice daily home use over a period of 42 days. All subjects were dispensed a standard fluoride-containing dentifrice and both toothbrushes were to be used in their respective Deep Clean modes. Safety and efficacy evaluations were performed at 14 and 42 days following Baseline. RESULTS: Two-hundred eighty-four subjects completed this trial (142 subjects per treatment group). Least squares mean (95% CI) estimates for reduction and percent reduction of gingivitis per Modified Gingival Index (MGI) following 42 days of product use for the SPC group were 1.17 (1.10, 1.24) and 45.68% (42.95%, 48.40%); for the OCA group they were 0.69 (0.62, 0.76) and 26.83% (24.10%, 29.56%). The mean difference (95% CI) between the two treatment groups was 0.48 (0.38, 0.58) and 18.85% (14.99%, 22.70%) for reduction and percent reduction, respectively. The lower limit of the 95% CI for the difference in Overall score between the two treatment groups was greater than the predefined non-inferiority margin (i.e., -0.10 or -5%); therefore SPC was declared non-inferior to OCA. In addition, since the 95% CI for the difference did not include zero, SPC was declared superior to OCA in the reduction of gingivitis per MGI at Day 42 (p-value < 0.0001). Similarly, for MGI at Day 14 and for GBI and MPI at Day 14 and Day 42, significantly larger reductions were observed for SPC compared to OCA (p-value < 0.0001). CONCLUSIONS: Philips Sonicare DiamondClean with Premium plaque control brush head (SPC) was statistically superior to the Oral-B 7000 with CrossAction brush head (OCA) in reducing gingival inflammation, gingival bleeding, and supragingival plaque following 14 and 42 days of home use. Both products were safe for use.

The Effect of Use of a Sonic Power Toothbrush and a Manual Toothbrush Control on Plaque and Gingivitis.

OBJECTIVES: To compare the ability of the Philips Sonicare DiamondClean power toothbrush and the ADA Reference manual toothbrush to reduce plaque and gingival inflammation by routine manual toothbrush users. METHODS: This was a randomized, single-blind, parallel-design study. Eligible subjects were generally healthy non-smokers who exhibited mild to moderate gingivitis upon study entry. Enrolled subjects were randomly allocated to commence twice-daily home use of either a Philips Sonicare DiamondClean (DiamondClean) power toothbrush or an ADA reference manual toothbrush (MTB) for a period of four weeks. Clinical safety and efficacy were assessed after a two- and four-week period of home use. Statistical analysis was performed for the modified intent to treat (mITT) population using a mixed model with the Baseline score as a covariate. RESULTS: A total of 182 volunteers were screened, 144 (72 per treatment) were randomized, and 142 subjects completed this study. Following four weeks of use, the Least Square (LS) Mean SE) percent reduction in surface plaque was 34.9% (1.8) for DiamondClean and 8.0% (1.7) for MTB, (p < 0.0001). At the same four-week time point, the LS Mean (SE) percent reduction in gingival inflammation for DiamondClean was 25.5% (1.9) and 19.1% (1.9) for MTB (p = 0.0213). For gingival bleeding, the LS Mean (SE) percent reduction in sites with gingival bleeding for DiamondClean was 57.4% (3.06) and 31.4% (3.04) for MTB (p < 0.0001). CONCLUSIONS: The Philips Sonicare DiamondClean power toothbrush was statistically significantly more effective than a manual toothbrush in reducing supragingival plaque, gingival inflammation, and gingival bleeding following a four-week period of home use. Both products were safe for home use.

Gingival Health and Plaque Regrowth Response Following a Four-Week Interdental Hygiene Intervention.

OBJECTIVES: To compare the efficacy of three adjunct interproximal cleaning methods versus a manual toothbrush alone on gingivitis, and demonstrate that the Philips Sonicare AirflossPro™ interproximal (IP) cleaning device provides a similar reduction in gingivitis and plaque compared to string floss. METHODS: A randomized, single-blind, parallel-design study was conducted on generally healthy adults exhibiting mild to moderate gingivitis. Eligible subjects were non-smokers, aged 18-65 years, with ≥ 0.5 per the Rustogi Modified Navy Plaque Index (RMNPI) and a Gingival Bleeding Index (GBI) of ≥ 1 on at least 10 sites. Eligible subjects were randomly assigned to use one of four oral hygiene regimens: manual toothbrush (MTB) alone; MTB plus string floss (SF); MTB plus Philips Sonicare AirflossPro used with Cool Mint Listerine® Antiseptic (AFPL); and MTB plus Philips Sonicare AirflossPro used with BreathRx™ (AFPB). Subjects were followed over a 28-day home-use period, with follow-up visits for efficacy and safety conducted at Days 14 and 28. All subjects were instructed to use the MTB twice daily and perform interproximal cleaning once daily, if assigned. Study efficacy endpoints included the Modified Gingival Index (MGI), Rustogi Modified Navy Plaque Index, and the Gingival Bleeding Index. RESULTS: Of 290 randomized subjects, 287 were followed to Day 14 and 286 were followed to Day 28. For the primary endpoint at Day 14, significantly larger reductions in MGI were observed in each of the three IP cleaning groups compared to MTB alone (p < 0.001). The adjusted mean reductions and standard error estimates (SE) for MGI expressed as a percent reduction from Baseline at Day 14 were: 0.22% (0.55%) for MTB; 4.30% (0.44%) for SF; 4.55% (0.45%) for AFPL; and 4.20% (0.44%) for AFPB. A non-inferiority test comparing AirflossPro to SF showed AirflossPro to be non-inferior to SF (p < 0.001). CONCLUSIONS: The addition of interproximal cleaning to manual tooth brushing statistically significantly reduces gingivitis and plaque compared to manual tooth brushing alone. Among the adjunct interproximal cleaning regimens, AirflossPro provides a similar reduction in gingivitis and plaque to string floss. All study regimens were safe on oral tissues.

[Violence, Burnout and Minor Psychiatric Disorders in Hospital Work]. / Violência, burnout e transtornos psíquicos menores no trabalho hospitalar.

OBJECTIVE: Identifying the violence suffered by the health team workers and their association with Burnout and minor psychiatric disorders. METHODS: Cross-sectional study with 269 health team professionals of a public hospital in southern Brazil. Data were collected through the use of the Survey Questionnaire: Workplace Violence in the Health Sector, Maslach Inventory Burnout and Self-Report Questionnaire. RESULTS: Workplace violence struck 63.2% of workers, prevailing mostly in women (p = 0.001), among nursing auxiliaries/technicians (p=0.014) and was associated with minor psychiatric disorders (p<0.05), as exposure to different forms of violence increased the chances of these disorders by 60% (CI 95%: 1.2-2.1). The three Burnout dimensions were also associated to violence at work (p<0.05). CONCLUSION: Health workers experience violence in the workplace and this exposure is associated with Burnout symptoms and minor psychiatric disorders.

Annexin II interactions with the annexin II receptor enhance multiple myeloma cell adhesion and growth in the bone marrow microenvironment.

Multiple myeloma (MM) is an incurable B-cell malignancy in which the marrow microenvironment plays a critical role in our inability to cure MM. Marrow stromal cells in the microenvironment support homing, lodging, and growth of MM cells through activation of multiple signaling pathways in both MM and stromal cells. Recently, we identified annexin II (AXII) as a previously unknown factor produced by stromal cells and osteoclasts (OCL) that is involved in OCL formation, HSC and prostate cancer (PCa) homing to the BM as well as mobilization of HSC and PCa cells. AXII expressed on stromal cells supports PCa cell lodgment via the AXII receptor (AXIIR) on PCa cells, but the role of AXII and AXIIR in MM is unknown. In this study, we show that MM cells express AXIIR, that stromal/osteoblast-derived AXII facilitates adhesion of MM cells to stromal cells via AXIIR, and OCL-derived AXII enhances MM cell growth. Finally, we demonstrate that AXII activates the ERK1/2 and AKT pathways in MM cells to enhance MM cell growth. These results demonstrate that AXII and AXIIR play important roles in MM and that targeting the AXII/AXIIR axis may be a novel therapeutic approach for MM.

Ancillary benefits of antenatal ultrasound: an association between the introduction of a low-cost ultrasound program and an increase in the numbers of women receiving recommended antenatal treatments.

BACKGROUND: In June of 2010, an antenatal ultrasound program was introduced to perform basic screening examinations at a health care clinic in rural Uganda. The impact of the program on the existing antenatal care infrastructure including the proportion and number of women receiving recommended antenatal care at clinic visits was unknown. The aim of this study was to investigate the relationship between the advent of the ultrasound program and the proportion of women receiving recommended antenatal interventions at their clinic visits. Change in the absolute numbers of antenatal services provided was also assessed. METHODS: Records at the Nawanyago clinic were reviewed to determine the total numbers of women receiving specific interventions before and after the advent of the ultrasound program including HIV testing, intermittent preventive therapy for malaria, presumptive anti-parasitic treatment, and provision of iron and folate for anemia. The rate at which these interventions were provided (number of interventions per clinic visit) was also assessed. The differences in absolute numbers of antenatal interventions before and after the introduction of the ultrasound program were assessed using the Wilcoxon rank-sum test. Differences in intervention rate were assessed using negative binomial regression modeling. RESULTS: The mean monthly numbers of women receiving each of these interventions increased significantly with the greatest increase seen in numbers of women receiving anemia and deworming treatments at +113% and +102% respectively (p < 0.001). The intervention rate increased for anemia treatment, deworming treatment, and 2nd dose of intermittent preventive therapy for malaria. A slight decrease in intervention rate was observed for 1st dose of malaria treatment with a rate ratio of 0.88 (0.79 - 0.98, 95% CI). Intervention rate for HIV testing was not significantly changed. CONCLUSION: The introduction of a low-cost antenatal ultrasound program at a health care clinic in rural Uganda was associated with increases in the number of women receiving specific recommended antenatal care interventions. Effect on intervention rates was mixed but showed an overall increase. The use of ultrasound in this context may provide a benefit to the maternal and neonatal health of the community.

Gfi1 expressed in bone marrow stromal cells is a novel osteoblast suppressor in patients with multiple myeloma bone disease.

Protracted inhibition of osteoblast (OB) differentiation characterizes multiple myeloma (MM) bone disease and persists even when patients are in long-term remission. However, the underlying pathophysiology for this prolonged OB suppression is unknown. Therefore, we developed a mouse MM model in which the bone marrow stromal cells (BMSCs) remained unresponsive to OB differentiation signals after removal of MM cells. We found that BMSCs from both MM-bearing mice and MM patients had increased levels of the transcriptional repressor Gfi1 compared with controls and that Gfi1 was a novel transcriptional repressor of the critical OB transcription factor Runx2. Trichostatin-A blocked the effects of Gfi1, suggesting that it induces epigenetic changes in the Runx2 promoter. MM-BMSC cell-cell contact was not required for MM cells to increase Gfi1 and repress Runx2 levels in MC-4 before OBs or naive primary BMSCs, and Gfi1 induction was blocked by anti-TNF-α and anti-IL-7 antibodies. Importantly, BMSCs isolated from Gfi1(-/-) mice were significantly resistant to MM-induced OB suppression. Strikingly, siRNA knockdown of Gfi1 in BMSCs from MM patients significantly restored expression of Runx2 and OB differentiation markers. Thus, Gfi1 may have an important role in prolonged MM-induced OB suppression and provide a new therapeutic target for MM bone disease.

[The specificities of communication in child nursing care]. / As especificidades da comunicação na assistência de enfermagem à criança.

This study aimed to identify the way nurses communicate with children and to analyze how this communication takes place during nursing care. It is a descriptive study that uses concepts associated with social representations. The authors interviewed 49 nurses who care for children in the hospital setting. Data collection occurred through semi-structured interviews. After thematic analysis, results emphasized the importance of spoken language, behavioral language and professional attitude. As evidenced, communication is presented as a phenomenon separate from child care, transcending the transmission of linear information. It is concluded that, in terms of understanding the communication phenomenon in child care, the way in which communication is presented and translated characterizes the relevance of nursing actions that point to a comprehensive perspective in child care.

Professional quality of life and occupational stress in nursing workers during the COVID-19 pandemic.

OBJECTIVE: To identify the levels of professional quality of life and the occupational stress in nursing professionals. METHOD: Cross sectional study conducted between April and August 2020, with nursing professionals working in inpatient units for clinical and surgical patients of a large hospital. The Work Stress Scale and the Professional Quality of Life Scale were applied. RESULTS: The sample consisted of 150 professionals, with a mean age of 43 ± 8.89 years, being 84.7% (127) female. The mean of the work stress scale was 1.9 (± 0.71), a moderate level of stress. It was found that compassion satisfaction had a median of 50.3 (9.1 - 64.6), burnout of 48.5 (32.2 - 84.8) and post-traumatic stress disorder of 47.1 (38.6 - 98.3). CONCLUSION: Stress at work and Compassion Fatigue were identified in the sample, especially in secondary-level professionals, demonstrating the need to implement strategies to reduce psycho-emotional harm in these professionals.

Effect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial.

OBJECTIVE: to assess the effect of cardiovascular biofeedback on nursing staff stress when compared to an activity without self-monitoring. METHOD: a randomized controlled clinical trial, carried out with nursing professionals from a university hospital. The intervention group (n=58) performed cardiovascular biofeedback, and the control (n=57) performed an online puzzle without self-monitoring, totaling nine meetings over three weeks. The outcome was assessed using the Stress Symptoms and Work-Related Stress scales, and the biological marker heart rate variability. The generalized estimating equations method was used. RESULTS: the intervention had no effect on self-reported instruments (p>0.050). However, there was an effect of time (p<0.050) on all heart rate variability indicators, demonstrating changes over the sessions. CONCLUSION: cardiovascular biofeedback showed promising results in the biological marker, suggesting that it can be used in nursing staff as a complementary therapy by promoting better autonomic nervous system regulation.

Effectiveness of health literacy and relaxing music on quality of sleep and risk for antenatal depression.

Background: Pregnant women experience increased sleep disturbances during the third trimester of their pregnancy, which may result in the development of psychological issues in the perinatal period. There is a dearth of interventional studies that combine health literacy and the provision of music for the benefit of pregnant women in South Asia. Aim: To determine the effectiveness of a combination of Comprehensive Health literacy And Relaxing Music (CHARM) interventions on quality of sleep and risk for antenatal depression among women visiting antenatal outpatient departments of a tertiary hospital in South India. Methods: A four-arm parallel-group randomized controlled trial was adopted; 128 low-risk primigravid women were recruited and randomly assigned to the four groups using block randomization. The interventions included relaxing music interventions, comprehensive health-literacy interventions, combinations of both as CHARM interventions, and standard antenatal care. All the interventions were provided for four weeks. The quality of sleep among pregnant women was assessed using the Pittsburgh Sleep Quality Index Scale at baseline and after four weeks of intervention. Women at risk of developing antenatal depression were screened using the Edinburgh Postnatal Depression Scale-Antenatal Version. Results: Pregnant women who received CHARM interventions had significant improvement in quality of sleep when compared with other interventions (F(3,124) =15.0, P < .001, effect size η p2= 0.27). Also, 38 (29.6%) of the included pregnant women were at risk of developing antenatal depression, which was reduced to 21 (16.4%) following the intervention. Conclusion: CHARM intervention could promote quality sleep and reduce the risk of developing antenatal depression, thereby improving perinatal mental health.