Atf3 links loss of epithelial polarity to defects in cell differentiation and cytoarchitecture.

Interplay between apicobasal cell polarity modules and the cytoskeleton is critical for differentiation and integrity of epithelia. However, this coordination is poorly understood at the level of gene regulation by transcription factors. Here, we establish the Drosophila activating transcription factor 3 (atf3) as a cell polarity response gene acting downstream of the membrane-associated Scribble polarity complex. Loss of the tumor suppressors Scribble or Dlg1 induces atf3 expression via aPKC but independent of Jun-N-terminal kinase (JNK) signaling. Strikingly, removal of Atf3 from Dlg1 deficient cells restores polarized cytoarchitecture, levels and distribution of endosomal trafficking machinery, and differentiation. Conversely, excess Atf3 alters microtubule network, vesicular trafficking and the partition of polarity proteins along the apicobasal axis. Genomic and genetic approaches implicate Atf3 as a regulator of cytoskeleton organization and function, and identify Lamin C as one of its bona fide target genes. By affecting structural features and cell morphology, Atf3 functions in a manner distinct from other transcription factors operating downstream of disrupted cell polarity.

dMyc is required in retinal progenitors to prevent JNK-mediated retinal glial activation.

In the nervous system, glial cells provide crucial insulation and trophic support to neurons and are important for neuronal survival. In reaction to a wide variety of insults, glial cells respond with changes in cell morphology and metabolism to allow repair. Additionally, these cells can acquire migratory and proliferative potential. In particular, after axonal damage or pruning the clearance of axonal debris by glial cells is key for a healthy nervous system. Thus, bidirectional neuron-glial interactions are crucial in development, but little is known about the cellular sensors and signalling pathways involved. In here, we show that decreased cellular fitness in retinal progenitors caused by reduced Drosophila Myc expression triggers non cell-autonomous activation of retinal glia proliferation and overmigration. Glia migration occurs beyond its normal limit near the boundary between differentiated photoreceptors and precursor cells, extending into the progenitor domain. This overmigration is stimulated by JNK activation (and the function of its target Mmp1), while proliferative responses are mediated by Dpp/TGF-ß signalling activation.

High Throughput Combinatorial Formatting of PcrV Nanobodies for Efficient Potency Improvement.

Improving potencies through concomitant blockage of multiple epitopes and avid binding by fusing multiple (different) monovalent Nanobody building blocks via linker sequences into one multivalent polypeptide chain is an elegant alternative to affinity maturation. We explored a large and random formatting library of bivalent (combinations of two identical) and biparatopic (combinations of two different) Nanobodies for functional blockade of Pseudomonas aeruginosa PcrV. PcrV is an essential part of the P. aeruginosa type III secretion system (T3SS), and its oligomeric nature allows for multiple complex binding and blocking options. The library screening yielded a large number of promising biparatopic lead candidates, revealing significant (and non-trivial) preferences in terms of Nanobody building block and epitope bin combinations and orientations. Excellent potencies were confirmed upon further characterization in two different P. aeruginosa T3SS-mediated cytotoxicity assays. Three biparatopic Nanobodies were evaluated in a lethal mouse P. aeruginosa challenge pneumonia model, conferring 100% survival upon prophylactic administration and reducing lung P. aeruginosa burden by up to 2 logs. At very low doses, they protected the mice from P. aeruginosa infection-related changes in lung histology, myeloperoxidase production, and lung weight. Importantly, the most potent Nanobody still conferred protection after therapeutic administration up to 24 h post-infection. The concept of screening such formatting libraries for potency improvement is applicable to other targets and biological therapeutic platforms.

Drosophila PS2 and PS3 integrins play distinct roles in retinal photoreceptors-glia interactions.

Cellular migration and differentiation are important developmental processes that require dynamic cellular adhesion. Integrins are heterodimeric transmembrane receptors that play key roles in adhesion plasticity. Here, we explore the developing visual system of Drosophila to study the roles of integrin heterodimers in glia development. Our data show that αPS2 is essential for retinal glia migration from the brain into the eye disc and that glial cells have a role in the maintenance of the fenestrated membrane (Laminin-rich ECM layer) in the disc. Interestingly, the absence of glial cells in the eye disc did not affect the targeting of retinal axons to the optic stalk. In contrast, αPS3 is not required for retinal glia migration, but together with Talin, it functions in glial cells to allow photoreceptor axons to target the optic stalk. Thus, we present evidence that αPS2 and αPS3 integrin have different and specific functions in the development of retinal glia.

Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review.

Objectives: Chronic dyspnea, a distressing symptom in patients with complex chronic conditions, is linked to higher risks of mortality. This study aimed to identify nursing interventions that could improve self-management for complex chronic patients, thereby enhancing control over chronic dyspnea. The findings intend to guide nursing care strategies that promote self-management among this population. Methods: We searched the databases Medline, Scopus, Web of Science, CINAHL, Cochrane Database of Systematic Reviews (CDSR), and Joanna Briggs Institute (JBI) databases were searched in December 2023. We included adult patients with complex chronic conditions with chronic dyspnoea. The team screened articles collaboratively, using Rayyan software. A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools. The review protocol is registered under the number CRD42023456021. Results: Our review included 18 studies that explored a variety of interventions for chronic dyspnea. We identified pharmacological interventions (such as oxygen therapy and inhalation treatments) and non-pharmacological approaches (including educational programs, breathing exercises, fluid intake management, body awareness techniques, peer support, emotional intelligence training, and the use of web applications). Those interventions empower patients, improve their ability to fulfill life roles, mitigate emotional distress, and improve overall quality of life. Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care. Conclusions: Promoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach, encompassing multidisciplinary interventions, individualized self-care education, peer engagement, and technological support. Current research on self-management inadequately addresses interventions targeting patient behaviour change. It highlights the need to delve deeper into the self-management process. Further research is needed to expand the evidence base and refine these interventions.

Heyde syndrome--the link between aortic stenosis and gastrointestinal bleeding.

Aortic valve stenosis can be complicated by gastrointestinal bleeding from angiodysplasia. A deficiency of high molecular weight multimers of von Willebrand factor (vWF) (type 2A von Willebrand disease) provides the link between this association, which is known as Heyde syndrome. Aortic valve replacement corrects the vWF abnormalities with long-term resolution of gastrointestinal bleeding. The authors present a case report and a review of this association.

Substernal Goiter: a case to remember.

Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.

Flucloxacillin-Induced Hepatotoxicity - Association with HLA-B*5701.

Drug-induced liver injury (DILI) to flucloxacillin is rare and is classified as idiosyncratic, as it is dependent on individual susceptibility, unpredictable, and dose-independent. The authors present the case of a 74 - year - old man with a history of monoclonal gammopathy under investigation and alcoholic habits of 24 g/day, with asthenia, anorexia, nausea, abdominal discomfort, and fever with three days of evolution. He was treated with two courses of antibiotic therapy with flucloxacillin to erysipelas previously (3 months and 2 weeks before admission). Lab tests showed serum AST levels of 349 U/L, ALT 646 U/L, alkaline phosphatase 302 U/L, GGT 652 U/L, total bilirubin 3.3 mg/dL and direct bilirubin 2.72 mg/dL. Infectious, autoimmune, and metabolic causes were ruled out. Magnetic resonance cholangiopancreatography showed normal results. Liver biopsy showed mild multifocal (predominantly microvesicular) steatosis; marked changes in the centrilobular areas (sinusoidal dilatation, marked congestion, hemorrhage, and multifocal hepatocyte collapse); expansion of the portal areas with the formation of bridges; proliferated bile ducts and inflammatory infiltrate of variable density, predominantly mononuclear type. The HLA-B*5701 screening test was positive. Hepatic biochemical tests remain abnormal with a significative increase in total bilirubin, which reached levels of 24.1 mg/dL, with the development of jaundice, pruritus, and choluria. DILI was assumed, and the patient was treated with ursodeoxycholic acid. There was favorable evolution, without evidence of blood coagulation dysfunction or encephalopathy. The analytic normalization was, however, slow, with evolution to chronicity. The authors present this case to remind the possibility of moderate/severe drug-induced liver injury to flucloxacillin, an antibiotic commonly used in clinical practice and association with the HLA-B * 5701 allele reported in the literature.

Ocular Melanoma Presenting as Masquerade Syndrome.

A masquerade syndrome is an ophthalmological entity where a neoplasm mimics an inflammatory condition. Ocular melanoma (chiefly uveal) may present with symptoms suggestive of intraocular inflammation such as endogenous endophthalmitis. Ocular melanoma is most commonly found in middle-aged and older caucasian patients. One-third of all uveal melanoma cases present asymptomatically. Early diagnosis facilitates treatment before ocular melanoma reaches metastatic stage IV. Current therapy options for stage IV patients are palliative care and clinical trial participation. LEARNING POINTS: Masquerade syndrome and intraocular haemorrhage can hide a neoplastic aetiology.A biopsy should be carried out for correct diagnosis if intraocular haemorrhage is present and a neoplastic pathology is suspected.A multidisciplinary approach should be adopted to enhance the quality of life of patients with metastatic ocular melanoma.

TGFß/Activin signalling is required for ribosome biogenesis and cell growth in Drosophila salivary glands.

Signalling by TGFß superfamily factors plays an important role in tissue growth and cell proliferation. In Drosophila, the activity of the TGFß/Activin signalling branch has been linked to the regulation of cell growth and proliferation, but the cellular and molecular basis for these functions are not fully understood. In this study, we show that both the RII receptor Punt (Put) and the R-Smad Smad2 are strongly required for cell and tissue growth. Knocking down the expression of Put or Smad2 in salivary glands causes alterations in nucleolar structure and functions. Cells with decreased TGFß/Activin signalling accumulate intermediate pre-rRNA transcripts containing internal transcribed spacer 1 regions accompanied by the nucleolar retention of ribosomal proteins. Thus, our results show that TGFß/Activin signalling is required for ribosomal biogenesis, a key aspect of cellular growth control. Importantly, overexpression of Put enhanced cell growth induced by Drosophila Myc, a well-characterized inducer of nucleolar hypertrophy and ribosome biogenesis.

Substernal Goiter: a case to remember

SUMMARY Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.

RESUMO O bócio é a hipertrofia da glândula tiroide localizada ou generalizada. Esta pode localizar-se na região cervical ou crescer através do mediastino. Os sinais e sintomas dependem do tamanho e da localização do bócio. Embora os fármacos e o iodo radioativo sejam frequentemente usados para tratar doenças tireoidianas, a presença do bócio subesternal sintomático é uma clara indicação para a cirurgia. A morte ou complicações pós-operatórias são raras. Apresentamos o caso de um homem de 71 anos com recorrência de patologia tireoidiana sob a forma de bócio subesternal e hipertireoidismo após tireoidectomia parcial. A importância desse caso relaciona-se com a evolução clínica, o volume e a localização do bócio e a abordagem cirúrgica e farmacológica desse tipo de patologia.

Flucloxacillin-Induced Hepatotoxicity - Association with HLA-B*5701

SUMMARY Drug-induced liver injury (DILI) to flucloxacillin is rare and is classified as idiosyncratic, as it is dependent on individual susceptibility, unpredictable, and dose-independent. The authors present the case of a 74 - year - old man with a history of monoclonal gammopathy under investigation and alcoholic habits of 24 g/day, with asthenia, anorexia, nausea, abdominal discomfort, and fever with three days of evolution. He was treated with two courses of antibiotic therapy with flucloxacillin to erysipelas previously (3 months and 2 weeks before admission). Lab tests showed serum AST levels of 349 U/L, ALT 646 U/L, alkaline phosphatase 302 U/L, GGT 652 U/L, total bilirubin 3.3 mg/dL and direct bilirubin 2.72 mg/dL. Infectious, autoimmune, and metabolic causes were ruled out. Magnetic resonance cholangiopancreatography showed normal results. Liver biopsy showed mild multifocal (predominantly microvesicular) steatosis; marked changes in the centrilobular areas (sinusoidal dilatation, marked congestion, hemorrhage, and multifocal hepatocyte collapse); expansion of the portal areas with the formation of bridges; proliferated bile ducts and inflammatory infiltrate of variable density, predominantly mononuclear type. The HLA-B*5701 screening test was positive. Hepatic biochemical tests remain abnormal with a significative increase in total bilirubin, which reached levels of 24.1 mg/dL, with the development of jaundice, pruritus, and choluria. DILI was assumed, and the patient was treated with ursodeoxycholic acid. There was favorable evolution, without evidence of blood coagulation dysfunction or encephalopathy. The analytic normalization was, however, slow, with evolution to chronicity. The authors present this case to remind the possibility of moderate/severe drug-induced liver injury to flucloxacillin, an antibiotic commonly used in clinical practice and association with the HLA-B * 5701 allele reported in the literature.

RESUMO A hepatotoxicidade à flucloxacilina é rara e classifica-se como idiossincrática, uma vez que é dependente da suscetibilidade individual, não expectável e independente da dose. Apresentamos o caso de um homem, 74 anos, antecedentes de gamapatia monoclonal e hábitos alcoólicos de 24 g/dia, com quadro de astenia, anorexia, náuseas, desconforto abdominal e febrícula com três dias de evolução. Referência a dois ciclos de antibioterapia com flucloxacilina por erisipela (três meses e duas semanas antes da admissão). Analiticamente com AST 349 U/L, ALT 646 U/L, FA 302 U/L, GGT 652 U/L, bilirrubina total 3,3 mg/dL, bilirrubina direta 2,72 mg/dL. Excluídas etiologias infecciosa, autoimune, metabólica, bem como patologia das vias biliares por colangio-RM. Biópsia hepática mostrou esteatose multifocal ligeira (predominantemente microvesicular); alterações acentuadas nas áreas centrolobulares (dilatação sinusoidal, congestão acentuada, hemorragia e colapso multifocal de hepatócitos); expansão das áreas portais com constituição de pontes; ductos biliares proliferados e infiltrado inflamatório de densidade variável, predominantemente de tipo mononucleado. Tipagem de HLA-B*5701 positiva. Agravamento analítico atingindo bilirrubina total 24,1 mg/dL, com desenvolvimento de icterícia, prurido e colúria. Admitida a hepatotoxicidade, iniciou terapêutica com ácido ursodesoxicólico. Verificou-se evolução favorável, sem evidência de coagulopatia ou encefalopatia. A normalização analítica foi, no entanto, lenta, com evolução para cronicidade. Os autores apresentam este caso para alertar para a possibilidade de hepatotoxicidade moderada a grave à flucloxacilina, antibiótico de uso comum na prática clínica e associação com o alelo HLA-B*5701 relatada na literatura.

A prática simulada em contexto de bradicardia extrema: contributos para a formação contínua de enfermeiros de uma equipa de emergência intra-hospitalar / Simulated practice in the context of extreme bradycardia: contributions to the continuing education of nurses from an in-hospital emergency team

A formação contínua e o desenvolvimento profissional são referidos na literatura como fatores essenciais para atingir e manter uma prestação de cuidados baseada na evidência e, consequentemente, cuidados de excelência. Todos os profissionais que prestam cuidados à pessoa em situação crítica, nomeadamente na Equipa de Emergência Médica Intra-Hospitalar (EEMI), têm a responsabilidade de aprofundar e manter atualizadas as suas competências em reanimação, onde a possibilidade de sobrevivência da pessoa em situação crítica, nomeadamente com bradicardia extrema, depende da eficácia da resposta à emergência. Considerando que a simulação no ensino de enfermagem é identificada como uma estratégia de formação de excelência em cuidados de saúde, esta promove a melhoria das competências e capacidades técnicas e não técnicas, reproduzindo em ambiente controlado situações reais. Este estudo tem como objetivo verificar os contributos da prática simulada nos ganhos percebidos e na satisfação dos Enfermeiros que integram a da EEMI, num Serviço de Urgência Básico (SUB), em contexto de bradicardia extrema. Para tal, foi desenvolvido um estudo quase-experimental, com desenho antes/após, de grupo único integrando uma amostra de oito enfermeiros, distribuídos em equipas de dois elementos. Numa fase preliminar, utilizou-se um questionário para validar a pertinência e viabilidade do estudo. Na segunda fase foi criada e validada uma grelha de observação de Competências Técnicas (GOCBE) que constituiu o instrumento de colheita de dados, juntamente com uma grelha de observação de Competências Não Técnicas Baseada em Ações, Escala de Ganhos Percebidos com as Experiências Clínicas Simuladas (EGPSA) e Escala de Satisfação com as Experiências Clínicas Simuladas (ESECS) validadas para a população portuguesa. As competências das equipas foram avaliadas pela sua exposição a um cenário simulado antes e depois (pós-teste) da participação no mesmo. Como resultados, observa-se um aumento da média global da GOCBE no 3º e 4º grupo, do 1º para o 2º momento (1,32 para 1,51 e 1,25 para 1,61, respetivamente). O grupo 2 manteve a mesma média e o grupo 1 diminuiu do 1º para o 2º momento de 1,44 para 1,04. Quanto às competências não técnicas, verifica-se um aumento das pontuações médias, do 1º para o 2º momento, em todos os grupos, sendo a competência não técnica "Comunicação" a que apresentou um maior aumento entre o 1º e 2º momento, em todos os grupos, de 0,58 para 0,89. Relativamente aos ganhos percebidos, constata-se um aumento dos valores médios, do 1º momento para o 2º momento, tanto na escala global, como nas suas cinco dimensões, particularmente, na dimensão Cognitiva e Interventiva, observando-se diferenças estatisticamente significativas, tanto na escala global (p=0,018), como nas suas dimensões, exceto na dimensão Atitudinal, que apesar da média ser superior no 2º momento, não se verificaram mudanças significativas entre as duas avaliações. Na satisfação com a intervenção (prática simulada), globalmente os enfermeiros da EEMI, mostraram-se muito satisfeitos, correspondendo à máxima pontuação da escala (10 pontos), constatando-se também nas suas três dimensões. Não se verificaram diferenças estatisticamente significativas entre o tempo de atividade profissional no SUB e a satisfação dos enfermeiros e não se encontrou correlação entre a satisfação dos enfermeiros e os ganhos percebidos após a intervenção. Considerando os resultados deste estudo, apesar de circunscritos a um contexto e com uma amostra bastante limitada, em alinhamento com a literatura, vislumbra-se que esta estratégia de formação contínua pode promover a aquisição e desenvolvimento de competências profissionais nos enfermeiros das EEMI, para uma intervenção de mais qualidade, designadamente, perante a pessoa em situação de bradicardia extrema.

Continuing education and professional development are referred to in the literature as essential factors to achieve and maintain evidence-based care and, consequently, excellent care. All professionals who provide care to a person in critical condition, namely in the Intra-Hospital Medical Emergency Team (EEMI), have the responsibility to deepen and update their skills in resuscitation, where the possibility of survival of the person in a critical situation, particularly with extreme bradycardia, it depends on the effectiveness of the emergency response. Considering that simulation in nursing education is identified as an excellent training strategy in health care, it promotes the improvement of technical and non-technical skills and abilities, reproducing real situations in a controlled environment. This study aims to check the contributions of simulated practice in the perceived gains and satisfaction of nurses who are part of the EEMI, in a Basic Emergency Service (SUB), in a context of extreme bradycardia. To this end, it was developed a quasi-experimental study, with a before/after design, of a single group, included a sample of eight nurses, distributed in teams of two elements. In a preliminary phase, a questionnaire was used to validate the relevance and feasibility of the study. In the second phase, a Technical Skills Observation Grid (GOCBE) was created and validated as a data collection instrument, along with an Action-Based Non-Technical Skills Observation Grid, Scale of Perceived Gains with Simulated Clinical Experiences (EGPSA) and the Satisfaction with Simulated Clinical Experiences Scale (ESECS) validated for the Portuguese population. The teams' skills were assessed by their exposure to a simulated scenario before and after (post-test) participation in it. As a result, there is an increase in the global average of GOCBE in the 3rd and 4th group, from the 1st to the 2nd moment (1.32 to 1.51 and 1.25 to 1.61, respectively). Group 2 maintained the same mean and group 1 decreased from the 1st to the 2nd moment from 1.44 to 1.04. As for non-technical skills, there is an increase in average scores, from the 1st to the 2nd moment, in all groups, with the non-technical competence "Communication" showing the greatest increase between the 1st and 2nd moment, in all the groups, from 0.58 to 0.89. Regarding perceived gains, there is an increase in the average values, from the 1st to the 2nd moment, both on the global scale and in its five dimensions, particularly in the Cognitive and Interventional dimension, observing statistically significant differences, both in the global scale (p=0.018), as in its dimensions, except for the Attitudinal dimension, which despite the average being higher in the 2nd moment, there were no significant changes between the two assessments. In terms of satisfaction with the intervention (simulated practice), overall, the EEMI nurses were very satisfied, corresponding to the maximum score on the scale (10 points), also found in its three dimensions. There were no statistically significant differences between the length of professional activity in the SUB and the nurses' satisfaction, and no correlation was found between the nurses' satisfaction and the gains perceived after the intervention. Considering the results of this study, despite being limited to a context and with a very limited sample, in line with the literature, it is clear that this continuing education strategy can promote the acquisition and development of professional skills in EEMI nurses, for a intervention of higher quality, namely, before the person in a situation of extreme bradycardia.

Characterization of Pousão pigments and extenders by micro-X-ray diffractometry and infrared and Raman microspectroscopy.

Seventeen samples from paintings by the distinguished 19th century Portuguese painter, Henrique Pousão, were characterized by micro-X-ray diffractometry and infrared and Raman microspectroscopy. The main advantages and limitations of each technique for pigment identification are outlined, revealing the need for the use of complementary techniques. Pousão's palette is discussed.