D-2-hydroxyglutarate supports a tolerogenic phenotype with lowered major histocompatibility class II expression in non-malignant dendritic cells and acute myeloid leukemia cells.

D-2-hydroxyglutarate (D-2-HG) accumulates in primary acute myeloid leukemia (AML) patients with mutated isocitrate dehydrogenase (IDH) and other malignancies. D-2-HG suppresses antitumor T cell immunity but little is known about potential effects on non-malignant myeloid cells. Here we show that D-2-HG impairs human but not murine dendritic cell (DC) differentiation, resulting in a tolerogenic phenotype with low major histocompatibility (MHC) class II expression. In line, IDH-mutated AML blasts exhibited lower expression of HLA-DP and were less susceptible to lysis by HLA-DP-specific T cells. Interestingly, D-2-HG reprogrammed metabolism towards increased lactate production in DCs and AML besides its expected impact on DNA demethylation. Vitamin C accelerated DNA demethylation, but only the combination of vitamin C and glycolytic inhibition lowered lactate levels and supported MHC class II expression. Our results indicate an unexpected link between the immunosuppressive metabolites 2-HG and lactic acid and suggest a potentially novel therapeutic strategy with combinations of anti-glycolytic drugs and epigenetic modulators (hypomethylating agents) or other therapeutics for the treatment of AML.

Unveiling the consequences of early human saliva contamination on membranes for guided bone regeneration.

AIMS: GBR membranes have various surface properties designed to elicit positive responses in regenerative clinical procedures; dental clinicians attempt to employ techniques to prevent the direct interaction of contaminated oral fluids with these biomaterials. However, saliva is uninterruptedly exhibited in oral surgical procedures applying GBR membranes, suggesting a persistent interaction with biomaterials and the surrounding oral tissues. This fundamental study aimed to investigate potential alterations in the physical, chemical, and key biological properties of membranes for guided bone regeneration (GBR) caused by isolated early interaction with human saliva. METHODS: A reproducible step-by-step protocol for collecting and interacting human saliva with membranes was developed. Subsequently, membranes were evaluated for their physicochemical properties, protein quantification, DNA, and 16S rRNA levels viability of two different cell lines at 1 and 7 days, and ALP activity. Non-interacted membranes and pure saliva of donors were applied as controls. RESULTS: Qualitative morphological alterations were noticed; DNA extraction and 16S quantification revealed significantly higher values. Furthermore, the viability of HGF-1 and MC3T3-E1 cells was significantly (p < .05) reduced following saliva interaction with biodegradable membranes. Saliva contamination did not prejudice PTFE membranes significantly in any biological assay. CONCLUSIONS: These outcomes demonstrated a susceptible response of biodegradable membranes to isolated early human saliva interaction, suggesting impairment of structural morphology, reduced viability to HGF-1 and MC3T3-E1, and higher absorption/adherence of DNA/16S rRNA. As a result, clinical oral procedures may need corresponding refinements.

Unlocking the potential of probiotic administration in caries management: a systematic review.

BACKGROUND: The use of prebiotics and/or probiotic bacteria with the potential to modulate the oral ecosystem may play an important role in the prevention and management of dental caries. To assess the evidence of the potential of pre/probiotics both in the prevention and treatment of dental caries, we focused on the PICO question "In individuals with caries, after probiotic administration, is there an improvement in outcomes directly related to caries risk and development?". METHODS: An extensive systematic search was conducted in electronic databases PubMed, Web of Science, Scopus and Cochrane, to identify articles with relevant data. This systematic review included trials performed in Humans; published in English; including the observation of patients with caries, with clear indication of the probiotic used and measuring the outcomes directly involved with the cariogenic process, including the quantification of bacteria with cariogenic potential. To evaluate the methodological quality of the studies, the critical assessment tool from the Joanna Briggs Institute was used. RESULTS: Eight hundred and fifty articles, potentially relevant, were identified. Following PRISMA guidelines 14 articles were included in this systematic review. Outcomes such as reduction of cariogenic microorganism counts, salivary pH, buffer capacity, and caries activity were assessed. The probiotic most often referred with beneficial results in dental caries outcomes is Lacticaseibacillus rhamnosus. Regarding the most used administration vehicle, in studies with positive effects on the caries management, probiotic supplemented milk could be considered the best administration vehicle. CONCLUSIONS: Evidence suggests a beneficial effect of probiotic supplemented milk (Lacticaseibacillus rhamnosus) as an adjuvant for caries prevention and management. However, comparable evidence is scarce and better designed and comparable studies are needed.

Mental Health Care in Primary Health Care: An Integrative Review.

In this study, we analyzed recent studies on mental health approaches developed in primary health care to identify the emphasis of such interventions, their technical feasibility for the setting in question, and their levels of evidence. An integrative review was conducted of primary studies from the LILACS, PubMed, Embase, CINAHL, and Web of Science databases using the PRISMA search strategy. Nineteen studies were identified with a high level of evidence that contribute to the advancement of knowledge in the area. However, academic, cultural, and linguistic barriers still need to be overcome to facilitate sharing of such interventions' findings and protocols.

Behavioural characteristics and abdominal obesity among Brazilian shift working women.

OBJECTIVE: To explore the association between behavioural characteristics with the prevalence of abdominal obesity (AO) among a population of Southern Brazilian shift working women. DESIGN: A cross-sectional study was conducted. AO was estimated using waist circumference (WC), and it was used to classify women as having AO (WC ≥ 88 cm). Prevalence ratios were estimated using Poisson regression with robust variance. SETTING: A large plastic utensils company in Southern Brazil. PARTICIPANTS: 450 female shift workers. RESULTS: The prevalence of the AO in the women shift workers was 44·5 % (95 % CI 40·0, 49·2 %). In night shift workers, the prevalence of AO was 56·1 % compared with 40·9 % among hybrid shift workers. After adjustments for covariates, women who were current smokers had a decrease in the prevalence of AO compared with those who never smoked. Women who had three or fewer meals per day had a 46 % increase in the AO prevalence compared with those eating more frequent meals. Night shift work was associated with increase in AO prevalence compared with hybrid shift (PR 1·33; 95 % CI: 1·08, 1·64). CONCLUSIONS: Our findings indicate that behavioural characteristics are associated with a high prevalence of AO in female shift workers, thus suggesting that behavioural modifications among women working shifts, such as increase in meal frequency and physical activity, may reduce AO.

Perspectives toward brain death diagnosis and management of the potential organ donor.

BACKGROUND: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical-legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. AIM: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance of potential organ donors for transplantation purposes. STUDY DESIGN: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. ETHICAL CONSIDERATIONS: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. RESULTS: Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation-transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical-legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse's duties toward the brain dead person. CONCLUSION: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario.

Chronic Liver Disease Questionnaire as a Tool to Evaluate the Quality of Life in Liver Transplant Candidates.

INTRODUCTION:: The advanced stage of liver disease causes impairments in the quality of life due to the physiological symptoms, besides the social and emotional stress. The aim of this study was to evaluate the quality of life of candidates for liver transplantation in specialized center in the interior of the state of São Paulo, Brazil. METHODS:: An observational study was carried out, with a quantitative approach. The sample was of convenience with the participation of 50 candidates for liver transplantation. Demographic characterization data, clinical data, and the Chronic Liver Disease Questionnaire were used to evaluate the quality of life. RESULTS:: The majority of the participants were male (68%), married (76%), with an average age of 55.7 years and average income of 2 to 3 minimum wages (42%). The main cause of liver disease was alcoholism (34%), mean time on the waiting list was 247.8 days, and mean model for end-stage liver disease was 20.5 points. The mean quality of life score was 2.9 points (standard deviation = 1.0) and the analysis of the 6 domains showed greater impairment of fatigue (2.2), activity (2.7), and concern (2.9) and better evaluation of systemic symptoms (3.4) and emotion (3.3). CONCLUSION:: Quality of life is impaired in most of the participants, indicating the need for greater attention and evaluation in the physical, mental, and social scope of this clientele.

Surgical count process: evidence for patient safety. / Processo de contagem cirúrgica: evidências para a segurança do paciente.

OBJECTIVE: To analyze the surgical count process according to reports of nurses working in surgical centers of a city in the state of São Paulo. METHODS: Cross-sectional study with a sample of 55 nurses. Data collection occurred from August to December 2013, with application of an instrument submitted to face and content validation, composed of data on variables regarding characteristics of nurses, hospital, and surgical count process. RESULTS: Fifty-two (94.5%) nurses reported that the surgical count process was carried out in their workplaces. A statistically significant association was found between the surgical count process and the type of institution (P=0.046), and between the presence of a surgical technologist and the processes for counting surgical instruments (P<0.001) and sponges (P=0.016). CONCLUSION: The results found contributed to understand how, by whom, and when the surgical count process was carried out in the studied hospital.

Information needs of family caregivers regarding liver transplant candidates. / Necessidades de informação do cuidador familiar de candidatos ao transplante de fígado.

Objective To assess the information needs of family caregivers of candidates on the waiting list for a liver transplant. Methods It is a cross-sectional study conducted in a transplant center in São Paulo State in the period between April and October of 2012. For the assessment of information needed, an instrument submitted to face and content value was used. The caregivers put 10 subjects in order according to their importance and the amount of interest they had in learning about each, prior to the transplant their family member would be subjected to. Sociodemographic characteristics were also recorded. For data analysis, descriptive statistics were used. Results 42 families participated in the study. The information need about liver disease complications, complications after transplantation and care needed after surgery had higher averages. Conclusions Knowing the information needs of caregivers is important to plan teaching-learning strategies aimed at improving assistance to patients and families in transplant programs.

Donation and Equitable Access to Organ, Tissue, and Cell Transplants: A Brazilian Perspective on the Strategy and Plan of Action 2019-2030.

OBJECTIVE: To position the Brazilian Transplant System within the context of the 4 Strategic Lines of Action proposed by the Pan-American Health Organization. METHOD: A specialist analysis was conducted through comparative analyses of the 4 Strategic Lines of Action, objectives, and indicators outlined in the Action Plan, along with the donation and transplantation system in accordance with Brazilian transplantation law. Subsequent to an in-depth review of the document issued by the health authority, a series of meetings involving 8 specialists in organ donation and transplantation were conducted. During these meetings, discussions were carried out with the objective of numerically interpreting each strategy presented in the document, and recommendations constructed. RESULTS: Four strategies were evaluated and only 2 of them the third (81,3%) and the fourth (90%) do not achieve the indicators to complete the objective related to equitable access to organ, tissue, and cell transplants in Brazil. CONCLUSION: The recommendations developed carry importance, as they are innovative and contribute to the establishment of priorities when shaping public policies. The report not only highlights indicators that were not satisfactorily met but also provides insights into the recommendations formulated to improve those indicators that have already been achieved and to work toward achieving those that have not yet been realized. Additionally, these recommendations can justify actions and establish priorities for research efforts in the field.

Using the Chat Generative Pre-trained Transformer in academic writing in health: a scoping review.

OBJECTIVE: to map the scientific literature regarding the use of the Chat Generative Pre-trained Transformer, ChatGPT, in academic writing in health. METHOD: this was a scoping review, following the JBI methodology. Conventional databases and gray literature were included. The selection of studies was applied after removing duplicates and individual and paired evaluation. Data were extracted based on an elaborate script, and presented in a descriptive, tabular and graphical format. RESULTS: the analysis of the 49 selected articles revealed that ChatGPT is a versatile tool, contributing to scientific production, description of medical procedures and preparation of summaries aligned with the standards of scientific journals. Its application has been shown to improve the clarity of writing and benefits areas such as innovation and automation. Risks were also observed, such as the possibility of lack of originality and ethical issues. Future perspectives highlight the need for adequate regulation, agile adaptation and the search for an ethical balance in incorporating ChatGPT into academic writing. CONCLUSION: ChatGPT presents transformative potential in academic writing in health. However, its adoption requires rigorous human supervision, solid regulation, and transparent guidelines to ensure its responsible and beneficial use by the scientific community.

Photoeducation and photoprotection among liver transplant candidates: a cross-sectional study.

The incidence of skin cancer after liver transplant ranges from 3% to 16%, considerably higher than that observed in the general population. Skin cancer causes 25% of deaths in patients who have survived more than 3 years after liver transplant. The objective of this study was to identify differences regarding the level of sun exposure, knowledge of potential risk factors, and photoprotection measures among liver transplant candidates and recipients. We carried out a prospective cross-sectional study with 100 patients enrolled at a liver transplant program in a Brazilian center. The patients were interviewed and received oral information regarding skin care and sun exposure. Results reveal that measures of photoprotection and photoeducation are more prevalent among recipients than among candidates. High degrees of solar exposure were observed more frequently among candidates, although recipients showed better knowledge about the risks of sun exposure. Educational actions concerning skin cancer prevention should be part of the guidelines given by the multidisciplinary team to the liver transplant patients, in particular, by the nursing team.

Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature.

OBJECTIVE: to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery. METHOD: integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner. RESULTS: surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted. CONCLUSION: conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.

Methodologies used by Nursing professionals in the production of educational videos: An integrative review. / Metodologías utilizadas por los profesionales de enfermería en la producción de videos educativos: revisión integradora.

OBJECTIVE: (1) The making of videos includes the pre-production, production and post-production phases. (2) Video is a powerful resource in the construction of knowledge and care practice. (3) The methods for making videos guarantee the quality of the content addressed. (4) Video enhances Nursing professionals' skills in the clinical practice. (5) Educational videos are essential in the training of Nursing professionals. to evaluate the diverse scientific evidence on the methodologies used by Nursing professionals in the production of educational videos. METHOD: an integrative review. The search for primary studies was carried out in the CINAHL, LILACS and MEDLINE/PubMed databases. The sample consisted of 19 research studies. The methodological quality of the studies included was assessed using a tool proposed by the Johns Hopkins Nursing Evidence-Based Practice and the results were analyzed in a descriptive form. RESULTS: the methodological stages used for the process to elaborate and make the videos include pre-production, production and post-production. The studies reveal that, for the most part, the stages were properly applied and/or described by the authors, in addition to contemplating the method adopted. However, in 14 studies there was no use of a methodological framework to ensure rigor in their conduction and in 11 presented validation by the target audience. CONCLUSION: the synthesis of knowledge showed that there is still a need for attention for the construction of educational videos regarding the methodological framework and validation by the target population. The rigorous execution of the methodological procedures necessary for the development of educational videos, aiming to encourage the acquisition of essential skills for the creation of high-quality teaching materials.

The P300 Auditory Evoked Potential in Cochlear Implant Users: A Scoping Review.

Introduction The P300 auditory evoked potential is a long-latency cortical potential evoked with auditory stimulation, which provides information on neural mechanisms underlying the central auditory processing. Objectives To identify and gather scientific evidence regarding the P300 in adult cochlear implant (CI) users. Data Synthesis A total of 87 articles, 20 of which were selected for this study, were identified and exported to the Rayyan search software. Those 20 articles did not propose a homogeneous methodology, which made comparison more difficult. Most articles (60%) in this review compare CI users with typical hearing people, showing prolonged P300 latency in CI users. Among the studies, 35% show that CI users present a smaller P300 amplitude. Another variable is the influence of the kind of stimulus used to elicit P300, which was prolonged in 30% of the studies that used pure tone stimuli, 10% of the studies that used pure tone and speech stimuli, and 60% of the studies that used speech stimuli. Conclusion This review has contributed with evidence that shows the importance of applying a controlled P300 protocol to diagnose and monitor CI users. Regardless of the stimuli used to elicit P300, we noticed a pattern in the increase in latency and decrease in amplitude in CI users. The user's experience with the CI speech processor over time and the speech test results seem to be related to the P300 latency and amplitude measurements.

[Information needs of liver transplant candidates: the first step of the teaching-learning process]. / Necessidades de informação de candidatos ao transplante de fígado: o primeiro passo do processo ensino-aprendizagem.

'Information need' is defined as a deficiency of information or skill related to a domain of life that is relevant to the patient. This study's objective was to identify the information needs of candidates on the waiting list for a liver transplant. This is a descriptive study and was conducted at a transplant center in the State of São Paulo-Brazil. The sample consisted of 55 patients and data were collected from March to June 2009. The results showed higher average scores for information needs concerning the preoperativeperiod. Identifying the information needs of liver transplant candidates is important to planning the teaching-learning process.

Postmitotic differentiation of human monocytes requires cohesin-structured chromatin.

Cohesin is a major structural component of mammalian genomes and is required to maintain loop structures. While acute depletion in short-term culture models suggests a limited importance of cohesin for steady-state transcriptional circuits, long-term studies are hampered by essential functions of cohesin during replication. Here, we study genome architecture in a postmitotic differentiation setting, the differentiation of human blood monocytes (MO). We profile and compare epigenetic, transcriptome and 3D conformation landscapes during MO differentiation (either into dendritic cells or macrophages) across the genome and detect numerous architectural changes, ranging from higher level compartments down to chromatin loops. Changes in loop structures correlate with cohesin-binding, as well as epigenetic and transcriptional changes during differentiation. Functional studies show that the siRNA-mediated depletion of cohesin (and to a lesser extent also CTCF) markedly disturbs loop structures and dysregulates genes and enhancers that are primarily regulated during normal MO differentiation. In addition, gene activation programs in cohesin-depleted MO-derived macrophages are disturbed. Our findings implicate an essential function of cohesin in controlling long-term, differentiation- and activation-associated gene expression programs.

Identification of people for palliative care in primary health care: integrative review. / Identificação de pessoas para cuidados paliativos na atenção primária: revisão integrativa.

This article aims to analyze the evidence available in the literature on the process of identifying adults and elderly people who can benefit from palliative care (PC) in primary health care (PHC). This is an integrative literature review carried out in PubMed, CINAHL, LILACS, Web of Science, and Embase. Eight studies were selected, in which different instruments and methods were distinguished with the purpose of identifying people who can benefit from PC in the context of PHC. The incorporation of these instruments into clinical practice is urgent in order to increase the reach and effectiveness of the services offered by health professionals, considering the current demographic and epidemiological profile that points to the increase of people with a potential need for PC. Different instruments have been successfully used to identify PC in the context of PHC. However, some have weaknesses, such as the fact that they only allow the identification of people with oncological diseases, leaving out other health conditions, which reinforces the need for further studies on this topic.

O objetivo deste artigo é analisar as evidências disponíveis na literatura sobre o processo de identificação de pessoas adultas e idosas que podem se beneficiar dos cuidados paliativos na atenção primária à saúde. Trata-se de revisão integrativa da literatura realizada nas bases de dados PubMed, CINAHL, LILACS, Web of Science e Embase. Foram selecionados oito estudos, nos quais foram distinguidos diferentes instrumentos com o propósito de identificar as pessoas que podem se beneficiar dos cuidados paliativos no contexto da atenção primária à saúde. A incorporação desses instrumentos na prática clínica é urgente, para aumentar o alcance e a efetividade dos serviços oferecidos pelos profissionais de saúde, considerando o perfil demográfico e epidemiológico atual que aponta para o aumento de pessoas com potencial necessidade de cuidados paliativos. Diferentes instrumentos têm sido utilizados com sucesso na identificação do cuidado paliativo no contexto da atenção primária à saúde. No entanto, alguns possuem fragilidades, como o fato de permitirem a identificação apenas das pessoas com doenças oncológicas, deixando de fora as demais condições de saúde, o que reforça a necessidade de mais estudos sobre esta temática.

Perceived self-efficacy among liver transplant candidates and recipients.

Self-efficacy is defined as one's belief that one can perform the necessary behaviors to achieve one's goals. This belief is one of the most powerful motivational predictors of how well a person will perform at almost any endeavor. Limited information is available, however, about self-efficacy in the organ transplantation population. This study aimed to identify the self-efficacy belief among liver transplant candidates and recipients and compare these results with demographic characteristics. The authors analyzed 100 patients who were candidates and recipients for liver transplantation in a Brazilian center. The average self-efficacy score for the candidates was significantly lower than for the recipients. Future investigation is necessary to explore possible interventions to be taken before and after liver transplantation that could influence self-efficacy of the organ transplantation patients.

Association of dietary patterns, number of daily meals and anthropometric measures in women in age of menopause.

OBJECTIVE: To investigate the association of dietary patterns, number of daily meals and anthropometric measures among women in age of menopause. METHODS: This was a transversal study with 320 women over 50 years old from Caxias do Sul, Brazil. The outcomes were body mass index (BMI) and waist circumference (WC). Multiple linear regression was performed. RESULTS: Three dietary patterns: regional, fruits and vegetables, and common Brazilian was identified by Principal Component Analysis. After adjustment, higher adoption of the regional dietary pattern was associated with increased BMI (ß = 0.56 [CI95% = 0.03-1.08], p = 0.037) and WC (ß = 1.28 [CI95% = 0.17-2,55], p = 0.047). The highest number of meals per day (>=5/day) was associated with reduced BMI (ß = -1.18 [CI95% = -2.30 to -0.05], p = 0.041) and WC (ß = -2.77 [CI95% = -5.41 to -0.13], p = 0.039), and a mid-afternoon snack BMI (ß = -2.16 [CI95% = -3.66 to -0.65], p = 0.005) and WC (ß = -5.76 [CI95% = -9.29 to -2.23], p = 0,001). The regional dietary pattern was inversely associated with have five or more meals per day (ß = -0.51 [CI95% = -0.84 to -0.18], p = 0.002) and have a mid-afternoon snack (ß = -0.63 [CI95% = -1.07 to -0.18], p = 0.006). The fruit and vegetables dietary pattern was positively associated with have five or more meals per day (ß = 0.35 [CI95% = 0.02-0.69], p = 0.034). CONCLUSION: The regional dietary pattern has resulted in higher BMI and WC measures and contributes to decreased meals per day, behavior associated with higher anthropometric measures.