Medical cannabis use in oncology and associated outcomes: A scoping review.

BACKGROUND: Natural and synthetic cannabinoids are being used worldwide to treat various symptoms in cancer patients. This study aims to map the therapeutic benefits and adverse effects associated with the use of cannabis-based drugs in these outcomes. METHODS: Following Joanna Briggs Institute guidelines a scoping review was conducted. The study protocol was available in the Open Science Framework public repository. An extensive search strategy involving databases like Cochrane Library, Embase, CINAHL, Medline/PubMed, Lilacs, Google Scholar, and Open Gray for gray literature analysis was executed by a skilled librarian. The inclusion criteria were primary studies (observational and randomized) that evaluated the efficacy and safety of cannabinoids in cancer patients. The review encompassed studies of diverse designs, publication years, and types, as long as they addressed cannabinoids' impact in oncology. RESULTS: Twenty-nine (82.86%) out of total of 35 were randomized and 6 (14.14%) were non-randomized. About 57.1% of studies utilized registered products as interventions, with THC being the most natural cannabinoid cited in variable doses and administration routes. Moreover, 62.85% of studies specified the cancer types (breast, lung, sarcomas, hematological and reproductive system), while only one study detailed cancer staging. The evaluated outcomes encompassed nausea and vomiting (77.14%), appetite (11.43%), pain (8.57%), and tumor regression (2.86%) across different proportions of studies. CONCLUSION: Cannabinoids show promise in managing pain, emesis, and anorexia/cachexia linked to cancer progression. New randomized clinical trials with a larger number of participants and observational studies on long-term safety are crucial to affirm their medicinal utility for cancer patients unresponsive to conventional drugs.

The Impact of Cervical Spinal Disease on Pharyngeal Swallowing Function.

PURPOSE: Spinal pathology is very common with advancing age and can cause dysphagia; however, it is unclear how frequently these pathologies affect swallowing function. This study evaluates how cervical spinal pathology may impact swallowing function in dysphagic individuals observed during videofluoroscopic swallowing studies (VFSSs). METHOD: A retrospective case-control study was performed on 100 individuals with dysphagia as well as age-/gender-matched healthy controls (HCs) with available VFSS. Spinal anatomy of patients was classified into two predetermined categories, and a consensus decision of whether spinal pathology influenced swallowing physiology was made. Validated swallow metrics, including Modified Barium Swallow Impairment Profile (MBSImP) component scores, Penetration-Aspiration Scale (PAS) maximum scores, and 10-item Eating Assessment Tool (EAT-10) scores, were compared between the spine-associated dysphagia (SAD), non-SAD (NSAD), and HC groups using Kruskal-Wallis one-way analysis of variance. RESULTS: Most patients with dysphagia had spinal pathology. Spinal pathology was judged to be the primary etiology of dysphagia in 16.9% of patients with abnormal spine pathology. Median EAT-10 scores were statistically different among the three groups, with the NSAD group scoring the highest and the HC group scoring the lowest. Similarly, median PAS scores were significantly different between dysphagic groups and HCs. Median MBSImP Oral Total scores were significantly different only between the NSAD group and HCs, whereas Pharyngeal Total score was not significantly different among the groups. CONCLUSIONS: Spinal pathology is commonly observed during VFSS and can contribute to dysphagia, resulting in worse swallowing-related outcomes when compared with HCs. Patients judged to have SAD tended to have better outcomes than patients with dysphagia from other etiologies, perhaps due to the progressive nature of spinal disease that allows for compensatory swallowing physiology over time.

A Primary Gastrointestinal Presentation and Novel Genetic Variant of Dyskeratosis Congenita in a Pediatric Patient.

Dyskeratosis congenita (DC) is a rare telomerase disorder affecting high turnover cells. Malfunction of protective proteins in DC results in patient genomes with shortened germline telomeres leading to genetic instability, cellular apoptosis, and overall cellular lifespan degradation. Classically, reports of DC described a triad of dysplastic nails, reticular skin pigmentation, and oral leukoplakia. However, more recent reports have focused on disease presentation affecting other high turnover organ systems including the gastrointestinal system. Patients may present with dysphagia because of esophageal stricture/web, diarrhea secondary to enteropathy or enterocolitis. We present a pediatric patient who presented with feeding difficulty secondary to an esophageal stricture as the primary manifestation of DC. She was diagnosed with Revesz Syndrome, a rare subtype of DC, along with a novel genetic variant not previously reported. This report serves to bring awareness to gastroenterologists that DC, though classically thought to present with dermatological findings, can present with primary gastrointestinal manifestations.

Michael White: marcos teóricos da Prática Narrativa / Michael White: theoretical references of the Narrative Practice

A pós-modernidade, o giro narrativo e os paradigmas construtivista e construcionista deram origem a variadas formas de intervenção psicoterapêutica, entre as quais se dará destaque ao conhecimento teórico que embasa a Prática Narrativa produzida por David Epston e Michael White, com ênfase para a contribuição de Michael White, autor que propõe coconstrução narrativa entre terapeuta e pessoa em terapia. A Prática Narrativa caracteriza-se pela desconstrução da estória saturada pelo problema, reconstrução narrativa e reautoria do self por meio de estórias preferidas e a partir da experiência vivida pela pessoa em terapia. O objetivo da pesquisa foi reconhecer, integrar e organizar as várias informações dispersas na literatura sobre a Prática Narrativa. Foi realizada revisão de literatura com destaque para a caracterização do panorama teórico da pós-modernidade e para a interlocução de Michael White com Bruner, Bateson, Foucault, Vygotsky e Derrida. O método utilizado foi levantamento bibliográfico de livros, artigos, dissertações e teses. O estudo teórico pode favorecer que o terapeuta crie contextos propiciadores de mudança, o que pode contribuir para o processo psicoterapêutico.(AU)

Post-modernity, narrative turn, constructivist and constructionist paradigms have opened various perspectives for the psychotherapeutic intervention. This study will highlight the theoretical knowledge that reinforces the Narrative Practice produced by David Epston and Michael White, with emphasis on the contribution of Michael White, an author who plans narrative co-construction between therapist and person in therapy. The Narrative Pratice is characterized for desconstruction of the saturated story, the narrative reconstruction and self reautoring through favorite stories basing on the experience of the person in therapy. The survey objective was to recognize, integrate and organize the diverse information dispersed throughout the Narrative Practice literature. It was performed a literature review emphasizing postmodernity characterization and Michael White's dialogue with Bruner, Bateson, Foucault, Vygotsky, and Derrida. The method used was the bibliographic survey of books, articles, dissertations, and theses. The theoretical study may favor the therapist to create contexts conducive to change, which may contribute to the psychotherapeutic process.(AU)

La posmodernidad, el giro narrativo y los paradigmas constructivista y construccionista dieron lugar a diversas formas de intervención psicoterapéutica, entre las que destacan el conocimiento teórico que subyace a la Práctica Narrativa producido por David Epston y Michael White, con énfasis en el aporte de Michael White, autor que propone co-construcción narrativa entre terapeuta y persona en terapia. La Práctica Narrativa se caracteriza por la deconstrucción del relato saturado por el problema, la reconstrucción narrativa y la reautoría del yo a partir de los relatos favoritos y de la experiencia vivida por la persona en terapia. El objetivo de la investigación fue reconocer, integrar y organizar las diversas informaciones dispersas en la literatura sobre Práctica Narrativa. Se realizó una revisión bibliográfica, destacando la caracterización del panorama teórico de la posmodernidad y el diálogo entre Michael White y Bruner, Bateson, Foucault, Vygotsky y Derrida. El método utilizado fue el levantamiento bibliográfico de libros, artículos, disertaciones y tesis. El estudio teórico puede favorecer al terapeuta para crear contextos propicios para el cambio, que pueden contribuir al proceso psicoterapéutico.(AU)

ATP6AP2 variant impairs CNS development and neuronal survival to cause fulminant neurodegeneration.

Vacuolar H+-ATPase-dependent (V-ATPase-dependent) functions are critical for neural proteostasis and are involved in neurodegeneration and brain tumorigenesis. We identified a patient with fulminant neurodegeneration of the developing brain carrying a de novo splice site variant in ATP6AP2 encoding an accessory protein of the V-ATPase. Functional studies of induced pluripotent stem cell-derived (iPSC-derived) neurons from this patient revealed reduced spontaneous activity and severe deficiency in lysosomal acidification and protein degradation leading to neuronal cell death. These deficiencies could be rescued by expression of full-length ATP6AP2. Conditional deletion of Atp6ap2 in developing mouse brain impaired V-ATPase-dependent functions, causing impaired neural stem cell self-renewal, premature neuronal differentiation, and apoptosis resulting in degeneration of nearly the entire cortex. In vitro studies revealed that ATP6AP2 deficiency decreases V-ATPase membrane assembly and increases endosomal-lysosomal fusion. We conclude that ATP6AP2 is a key mediator of V-ATPase-dependent signaling and protein degradation in the developing human central nervous system.

Sulcal FLAIR hyperintensity after CSF removal in two patients with intracranial hypertension.

Sulcal hyperintensity on fluid-attenuated inversion recovery (FLAIR) sequence is a frequently encountered finding that could be due to an abnormality of cerebrospinal fluid, a secondary finding related to an intracranial pathologic process, or be artifactual or iatrogenic. Here we present two cases of sulcal FLAIR hyperintensity in the setting of intracranial hypotension after CSF removal for intracranial hypertension.

Inhibition of mTOR Signaling and Clinical Activity of Rapamycin in Head and Neck Cancer in a Window of Opportunity Trial.

PURPOSE: We studied the impact of mTOR signaling inhibition with rapamycin in head and neck squamous cell carcinoma (HNSCC) in the neoadjuvant setting. The goals were to evaluate the mTOR pathway as a therapeutic target for patients with advanced HNSCC, and the clinical safety, antitumor, and molecular activity of rapamycin administration on HNSCC. PATIENTS AND METHODS: Patients with untreated stage II-IVA HNSCC received rapamycin for 21 days (day 1, 15 mg; days 2-12, 5 mg) prior to definitive treatment with surgery or chemoradiation. Treatment responses were assessed clinically and radiographically with CT and FDG-PET. Pre- and posttreatment biopsies and blood were obtained for toxicity, immune monitoring, and IHC assessment of mTOR signaling, as well as exome sequencing. RESULTS: Sixteen patients (eight oral cavity, eight oropharyngeal) completed rapamycin and definitive treatment. Half of patients were p16 positive. One patient had a pathologic complete response and four (25%) patients met RECIST criteria for response (1 CR, 3 PR, 12 SD). Treatment was well tolerated with no grade 4 or unexpected toxicities. No significant immune suppression was observed. Downstream mTOR signaling was downregulated in tumor tissues as measured by phosphorylation of S6 (P < 0.0001), AKT (P < 0.0001), and 4EBP (P = 0.0361), with a significant compensatory increase in phosphorylated ERK in most patients (P < 0.001). Ki67 was reduced in tumor biopsies in all patients (P = 0.013). CONCLUSIONS: Rapamycin treatment was well tolerated, reduced mTOR signaling and tumor growth, and resulted in significant clinical responses despite the brief treatment duration, thus supporting the potential role of mTOR inhibitors in treatment regimens for HNSCC.

RADIATION DOSE AND IMAGE QUALITY IN PEDIATRIC HEAD CT.

Our goal was to define a pediatric head CT protocol able to provide images of diagnostic quality, using the least amount of radiation, in children <10 years of age, while using a filtered back projection reconstruction algorithm. Image quality of 119 pediatric head CTs was assessed using a 5-point scoring system. Exams with scores ≥2.5 were considered of sufficient diagnostic quality. The contrast-to-noise ratio (CNR) was also measured. For children <1 year and 1-9 years, all studies performed with CTDIvol ≥ 20.1 mGy (range: 9-46 mGy) and CTDIvol ≥ 27.5 mGy (range: 15-60 mGy) yielded images of diagnostic quality. All diagnostic studies had a minimum CNR of 1.4. These CTDIvol values represent a good balance between image quality and radiation burden. This information can be helpful in designing pediatric head CT protocols with further dose-reduction, namely, iterative reconstruction algorithms and automated exposure control.

Current Radiographic Iodinated Contrast Agents.

Millions of radiologic examinations requiring the use of iodinated contrast are performed yearly in North America. Triiodobenzoic acid, the contrast agent molecule currently in use, is a benzene ring covalently bonded to the 3 iodine atoms. Iodinated contrast media can be divided in 4 categories: ionic monomers, ionic dimers, nonionic monomer, and nonionic dimers. Currently, second- and third-generation nonionic low-osmolar and iso-osmolar contrast media are used in clinical practice. The search for a safer and more effective iodinated contrast agents remains an ongoing challenge and important research topic.

Microparticles derived from obese adipose tissue elicit a pro-inflammatory phenotype of CD16+, CCR5+ and TLR8+ monocytes.

Macrophage infiltration into adipose tissue (AT) is a hallmark of the chronic inflammatory response in obesity and is supported by an intense monocyte migration towards AT. Although it has been detected an increased proportion of circulating CD16+ monocyte subsets in obese subjects, the mechanisms underlying this effect and the contribution of these cells to the inflamed profile of obese AT are still poorly understood. We investigated whether factors secreted by human obese omental AT could polarize monocytes to CD16+ enriched phenotype, and how these changes could modify their migratory capacity towards adipose tissue itself. We show that explants of human obese omental AT, obtained during bariatric surgery, released higher levels of MIP1-α, TNFα, leptin and also VEGF, together with increasing amounts of microparticles (MP), when compared to explants of lean subcutaneous AT. A higher content of circulating MP derived from preadipocytes and leukocytes was also detected in plasma of obese subjects. Conditioned media or MP released from obese omental AT increased CD16 and CCR5 expression on CD14+CD16- monocytes and augmented their migratory capacity towards the conditioned media from obese omental AT, itself. This effect was inhibited when MIP1-α was neutralized. Additionally, we demonstrate that MP derived from obese omental AT carry and transfer TLR8 to monocytes, thus triggering an increase in CD16 expression in those cells. Our data shows a positive feedback loop between blood monocytes and obese omental AT, which releases chemotactic mediators and TLR8-enriched MP, thus inducing an up-regulation of CD16+ monocytes, favoring leukocyte infiltration in the obese omental AT.

Practical Implications for an Effective Radiology Residency Quality Improvement Program for Milestone Assessment.

Utilization of a radiology resident-specific quality improvement (QI) program and curriculum based on the Accreditation Council for Graduate Medical Education (ACGME) milestones can enable a program's assessment of the systems-based practice component and prepare residents for QI implementation post graduation. This article outlines the development process, curriculum, QI committee formation, and resident QI project requirements of one institution's designated radiology resident QI program. A method of mapping the curriculum to the ACGME milestones and assessment of resident competence by postgraduate year level is provided. Sample projects, challenges to success, and lessons learned are also described. Survey data of current trainees and alumni about the program reveal that the majority of residents and alumni responders valued the QI curriculum and felt comfortable with principles and understanding of QI. The most highly valued aspect of the program was the utilization of a resident education committee. The majority of alumni responders felt the residency quality curriculum improved understanding of QI, assisted with preparation for the American Board of Radiology examination, and prepared them for QI in their careers. In addition to the survey results, outcomes of resident project completion and resident scholarly activity in QI are evidence of the success of this program. It is hoped that this description of our experiences with a radiology resident QI program, in accordance with the ACGME milestones, may facilitate the development of successful QI programs in other diagnostic radiology residencies.

Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone.

Subdural hematomas (SDHs) comprise a significant percentage of missed intracranial hemorrhage on axial brain CT. SDH detection rates could be improved with the addition of reformatted images. Though performed at some centers, the potential additional diagnostic sensitivity of reformatted images has not yet been investigated. The purpose of our study is to determine if the addition of coronal and sagittal reformatted images to an axial brain CT increases the sensitivity and specificity for detection of acute traumatic SDH. We retrospectively reviewed consecutive brain CTs acquired for acute trauma that contained new SDHs. An equivalent number of normal brain CTs served as control. Paired sets of images were created for each case: (1) axial images only ("axial only") and (2) axial, coronal, sagittal images ("reformat added"). Three readers interpreted both the axial only and companion reformat added for each case, separated by 1 month. Reading times and SDH detection rates were compared. One hundred SDH and 100 negative examinations were collected. Sensitivity and specificity for the axial-only scans were 75.7 and 94.3 %, respectively, compared with 88.3 and 98.3 % for reformat added. There was a 24.3 % false negative (missed SDH) rate with axial-only scans versus 11.7 % with reformat added (p = <0.001). Median reader interpretation times were longer with the addition of reformatted images (125 versus 89 s), but this difference was not significant (p = 0.23). The addition of coronal and sagittal images in trauma brain CT resulted in improved sensitivity and specificity as well as a reduction in SDH false negatives by greater than 50 %. Reformatted images substantially reduce the number of missed SDHs compared with axial images alone.

Importance of genetic testing in global health during the evaluation of familial microcephaly.

A focused genetic workup is useful in determining the cause of familial microcephaly, especially in the setting of mildly different phenotypes. As illustrated by this case from an impoverished international urban location, one must not assume the etiology for the apparent familial microcephaly is the same for all affected members.

Abhyanga no manejo do estresse: revisão de literatura / Aabhyanga on stress management: integrative literature review

Abhyanga ajuda a reduzir estresse? Foram consultados artigos, teses e dissertações publicados durante o período de janeiro de 2009 a junho de 2014, em onze bancos de dados: Bon, RCAAP, ERIC, Google Acadêmico, Pubmed, Scielo, Bireme, LILACS, Capes, Free Medical Jour-nals e Bvsalud. As palavras-chave utilizadas foram: 1. Ayurvedic Abhyanga Massage; 2. Ayurvedic Massage and stress; 3. Ayurveda and stress e 4. Abhyanga and stress. Três publicações trataram do efeito do abhyanga em indivíduos saudáveis e trouxeram indícios da importância do abhyanga sobre o sistema imunológico, redução da experimentação subjetiva de estresse, redução da taxa de batimentos cardíacos e diminuição de pressão arterial em sujeitos hipertensos. Quatro publicações trataram do efeito do abhyanga para aliviar problemas orgânicos. Avaliaram a efetividade do abhyanga para tratamento da espondilose cervical, osteoartrite de joelhos e dermatite seborréica. Nesses estudos, o procedimento terapêutico abhyanga mostrou-se efetivo tanto para prevenção de algumas doenças, como para tratamento de doenças já instaladas. Nos estudos revisados neste artigo foram observa¬das alterações bioquímicas que favoreceram o fortalecimento do sistema imunológico e que podem estar relacionados à ativação do sistema nervoso parassimpático e da resposta de relaxamento.(AU)

Does abhyanga help to reduce stress? Articles and discussions published during the period of January of 2009 to June of 2014 had been consulted in eleven ddata bases: B-on, RCAAP, ERIC, Google Acadêmico, Pubmed, Scielo, Bireme, LILACS, Capes, Free Medical Journals and Bvsalud. Keywords used: 1.Ayurvedic Abhyanga Massage; 2.Ayurvedic Massage and stress; 3.Ayurbeda and stress and 4.Abhyanga and stress. Three publications had dealt with the effect of abhyanga in healthful individuals and had brought indications of the importance of abhyanga on the immunologic system, reduction of the subjective experimentation of stress, heart tax reduction and blood pressure reduction for hypersensitive citizens. Four publications had dealt with the effect of abhyanga to alleviate organic problems and had evaluated the efectiveness of abhyanga for cervical spondylolysis, osteoarthritis of knees and dandruff, In the selected publications, abhyanga procedure showed to be effective for illness prevention as well as for already installed ilnesses treatment. It was observed in these studies biochemical alterations that help immunologic system empowerment that can be related to parasympathetic nervous system activation and relaxation response.(AU)

Crenças, valores e atitudes dos familiares conviventes com pacientes coronariopatas / Beliefs, values and attitudes of cohabiting relatives of coronary artery disease patients / Creencias, valores y actitudes de familiares de pacientes con coronariopatía

A alta incidência e prevalência da doença coronariana é evidente no Brasil e no mundo. A concepção de saúde e enfermidade influencia nas atitudes e condutas dos indivíduos diante do processo saúde doença e afeta o desempenho e o desenvolvimento do núcleo familiar. O objetivo foi analisar crenças, valores e atitudes dos familiares conviventes com pacientes com síndrome coronariana aguda sobre a doença coronariana. Trata-se de estudo transversal com abordagem qualitativa realizado em um Hospital Universitário. A amostra foi composta de nove familiares, mediante uma entrevista semi estruturada. Os dados foram coletados por meio de instrumentos com questões elaboradas tendo como base as premissas do referencial teórico e avaliados segundo o Modelo de Crença em Saúde. Os familiares tinham entre 26 e 66 anos. As categorias suscetibilidade, severidade, benefícios e barreiras percebidas derivadas do Modelo de Crença em Saúde, assim como a categoria conscientização e mudança, mostraram que os familiares possuem conhecimento sobre os aspectos preventivos e de controle das consequências da doença coronariana, porém as crenças e valores adquiridos ao longo de suas vidas, influenciados pelo contexto cultural, social, econômico, emocional e principalmente familiar, interferem nos comportamentos preventivos da doença e promotores de saúde. A despeito do conhecimento que os familiares conviventes possuem sobre a doença, o enfermeiro precisa adequar o processo educacional para minimizar os conflitos decorrentes de crenças, valores e contexto do ambiente familiar, facilitar e promover a incorporação de novos hábitos.

The high incidence and prevalence of coronary heart disease is evident in Brazil and worldwide. The concept that individuals have on health andillness influences their attitudes and behaviors before the health-disease process and affects the performance and development of the familynucleus. The objective was to analyze beliefs, values and attitudes of family members that live with patients with acute coronary syndrome ofcoronary heart disease. This is a cross-sectional study with qualitative approach conducted at a university hospital. The sample consisted ofnine relatives of patient. Semi-structured interviews were applied. Data were collected through instruments with questions prepared upon theassumptions of the theoretical framework. Data were evaluated according to the Health Belief Model. Family members were aged between 26 and66 years. The categories susceptibility, severity, benefits and perceived barriers derived from Health Belief Model, as well as the categories awarenessand change, showed that family members have knowledge about the prevention and control aspects of the consequences of coronary heart disease.However, the beliefs and values acquired throughout their lives, influenced by cultural, social, economic, emotional and especially family context,hinder behaviors with preventive and health promoter character. Despite the knowledge that family member of coronary patients have about thedisease, nurses need to tailor the educational process aiming to minimize conflicts arising from beliefs, values and family environment context, aswell as facilitate and promote the incorporation of new habits.

La elevada incidencia y prevalencia de la enfermedad coronaria en Brasil y en el mundo es evidente. El concepto de salud y enfermedad influye en las actitudesy comportamientos de los individuos en el proceso de salud-enfermedad y afecta el rendimiento y desarrollo del núcleo familiar. El objetivo del presenteestudio fue analizar las creencias, valores y actitudes de familiares que conviven con pacientes con síndrome coronario agudo de la enfermedad arterialcoronaria. Se trata de un estudio cualitativo transversal realizado en un hospital universitario. La muestra estaba compuesta por nueve familiares. Los datosfueron recogidos en entrevistas semiestructuradas a través de instrumentos con preguntas preparadas en base a los supuestos del marco teórico según elModelo de Creencias en Salud. Los familiares tenían entre 26 y 66 años. Las categorías “susceptibilidad”, “gravedad”, “beneficios” y “barreras” percibidasderivadas del modelo Creencias en Salud, así como la categoría “concienciación y cambio”, mostraron que los familiares tienen conocimiento sobre losaspectos de prevención y control de las consecuencias de la enfermedad cardíaca coronaria. Sin embargo, las creencias y valores adquiridos durante toda lavida, influenciados por el contexto cultural, social, económico y emocional de la familia interfieren con los comportamientos preventivos de la enfermedad ypromotores de la salud. A pesar del conocimiento que los familiares tienen sobre la enfermedad, los enfermeros precisan adecuar el proceso educativo paraminimizar los conflictos resultantes de las creencias, valores y contexto familiar para facilitar y promover la incorporación de nuevos hábitos.

Sistematização da assistência de enfermagem na visão de enfermeiros / Sistematización de la asistencia de enfermería en la visión de las enfermeras / Systematization of nursing care in nursing vision

Introdução: Configurada como uma metodologia científica estruturada para qualificar o cuidado, a Sistematização da Assistência de Enfermagem é um dos meios que o enfermeiro dispõe para aplicar seus conhecimentos técnico-científicos e humanos na assistência ao paciente e caracterizar sua prática profissional. Objetivo: Identificar como os enfermeiros de uma Unidade de Terapia Intensiva compreendem a Sistematização da Assistência de Enfermagem. Material e Método: Estudo transversal, qualitativo, desenvolvido por meio de entrevistas e análise de conteúdo. Os dados foram coletados através de entrevista semiestruturada e analisados segundo a técnica de Giorgi, a qual assume três significativos conceitos provenientes da proposta de pesquisa fenomenológica. Resultados: As três categorias emergentes foram designadas como: planejamento e organização, compreensão e priorização para a realização da sistematização. Conclusão: Embora os enfermeiros entendam a importância da Sistematização da Assistência de Enfermagem para a melhoria da qualidade do serviço prestado ao cliente, compreendem haver um déficit relacionado ao conhecimento teórico-prático, dificultando o produto final desse tipo de ação pertinente ao enfermeiro.

Introduction: Configured as a scientific methodology structured to qualify the care, the Systematization of Nursing Care is one of the ways through which nurses can apply their technical-scientific and human knowledge in patient care and characterize their professional practice. Objective: To identify how nurses of an intensive care unit understand the systematization of nursing care. Material and Methods: It is a cross-sectional study, developed through qualitative interviews and content analysis. Data were collected through semi-structured interviews and analyzed according to Giorgi technique, which takes three significant concepts from the phenomenological research proposal. Results: The three established categories were designated as: planning and organizing, understanding and prioritization for the realization of the systematization. Conclusion: Although nurses understand the importance of Nursing Care Systematization for the improvement of customer service quality, they realize that there is a deficit related to the theoretical and practical knowledge, hindering the final product of this type of action relevant to the nurse.

Introducción: Se configura como una metodología científica estructurada para calificar la sistematización de la asistencia de los cuidados de enfermería, es una manera de que las enfermeras tienen que aplicar sus conocimientos técnico-científico y humano en la atención al paciente y determinar las características de la práctica profesional. Objetivo: Identificar cómo las enfermeras de la unidad de cuidados intensivos incluyen la sistematización de la atención de enfermería. Métodos: Estudio transversal, desarrollado a través de entrevistas cualitativas y análisis de contenido. Los datos fueron recolectados a través de entrevistas semi-estructuradas y analizados según la técnica de Giorgi, que lleva tres conceptos importantes de la propuesta de investigación fenomenológica. Resultado: las tres categorías establecidas fueron designados como: planificación y organización, la comprensión y el establecimiento de prioridades para la realización de la sistematización. Conclusión: A pesar de que las enfermeras entienden la importancia de la sistematización de la asistencia de enfermería para la mejora de la calidad del servicio al cliente, se dan cuenta que hay un déficit en relación con los conocimientos teóricos y prácticos que dificulta el producto final de este tipo de acción correspondiente a la enfermera.

Redefining the Pediatric Phenotype of X-Linked Monocarboxylate Transporter 8 (MCT8) Deficiency: Implications for Diagnosis and Therapies.

X-linked monocarboxylate transporter 8 (MCT8) deficiency results from a loss-of-function mutation in the monocarboxylate transporter 8 gene, located on chromosome Xq13.2 (Allan-Herndon-Dudley syndrome). Affected boys present early in life with neurodevelopment delays but have pleasant dispositions and commonly have elevated serum triiodothyronine. They also have marked axial hypotonia and quadriparesis but surprisingly little spasticity early in their disease course. They do, however, have subtle involuntary movements, most often dystonia. The combination of hypotonia and dystonia presents a neurorehabilitation challenge and explains why spasticity-directed therapies have commonly produced suboptimal responses. Our aim was to better define the spectrum of motor disability and to elucidate the neuroanatomic basis of the motor impairments seen in MCT8 deficiency using clinical observation and brain magnetic resonance imaging (MRI) in a cohort of 6 affected pediatric patients. Our findings identified potential imaging biomarkers and suggest that rehabilitation efforts targeting dystonia may be more beneficial than those targeting spasticity in the prepubertal pediatric MCT8 deficiency population.

Infarct patterns, collaterals and likely causative mechanisms of stroke in symptomatic intracranial atherosclerosis.

BACKGROUND: There are limited data on the specific mechanisms of stroke in patients with intracranial atherosclerotic stenosis (ICAS). We undertook this study to describe infarct patterns and likely mechanisms of stroke in a large cohort of patients with ICAS, and to evaluate the relationship of these infarct patterns to angiographic features (collaterals, stenosis location and stenosis severity). METHODS: We evaluated infarct patterns in the territory of a stenotic intracranial artery on neuroimaging performed at baseline and during follow-up if a recurrent stroke occurred in patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We defined the likely mechanism of stroke (artery-to-artery embolism, perforator occlusion, hypoperfusion or mixed) according to the site of ICAS and based on the infarct patterns on neuroimaging. Collaterals were assessed using American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grades, and stenosis severity using the WASID trial's measurement technique. We evaluated the association of infarct patterns with angiographic features using χ(2) tests. RESULTS: The likely mechanisms of stroke based on the infarct patterns at baseline in the 136 patients included in the study were artery-to-artery embolism (n = 69; 50.7%), perforator occlusion (n = 34; 25%), hypoperfusion (n = 12; 8.8%) and mixed (n = 21; 15.5%). Perforator-occlusive infarcts were more frequent in the posterior circulation, and mixed patterns were more prevalent in the anterior circulation (both p < 0.01). Most of the mixed patterns in the anterior circulation combined small pial or scattered multiple cortical infarcts with infarcts in border-zone regions, especially the cortical ones. Isolated border-zone infarcts were not significantly associated with a poor grading for collaterals or the severity of stenosis. Among 47 patients with a recurrent infarct during follow-up, the infarct patterns suggested an artery-to-artery embolic mechanism in 29 (61.7%). CONCLUSIONS: Artery-to-artery embolism is probably the most common mechanism of stroke in both the anterior and the posterior circulations in patients with ICAS. An extension of intracranial atherosclerosis at the site of stenosis into adjacent perforators also appears to be a common mechanism of stroke, particularly in the posterior circulation, whereas hypoperfusion as the sole mechanism is relatively uncommon. Further research is important to accurately establish the specific mechanisms of stroke in patients with ICAS, since preliminary data suggest that the underlying mechanism of stroke is an important determinant of prognosis.

[Meaning of living with external fixation for grade III open fracture of lower limbs: patient view]. / Significado de conviver com fixação externa por fratura exposta grau III em membros inferiores: o olhar do paciente.

The present study is aimed to understand the meaning of living with an external fixation device for grade III open fractures of the lower limbs from the perspective of the patient. The data were collected with six young adults who were undergoing outpatient orthopedic treatment in a public hospital in the city of São Paulo, through semi-structured interviews with open questions, between June and August 2010. Seeking to understand the meaning of this experience, we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon "try to live in spite of feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

Significado de conviver com fixação externa por fratura exposta grau III em membros inferiores: o olhar do paciente / Meaning of living with external fixation for grade III open fracture of lower limbs: patient view / Significado de la vida con fijación externa por fractura expuesta grado III en miembros inferiores: la mirada del paciente

O objetivo deste estudo foi compreender o significado de conviver com fixação externa por fratura exposta grau III em membros inferiores, sob o olhar do paciente. Os dados foram coletados com seis adultos jovens que faziam tratamento ambulatorial ortopédico, em um hospital público da cidade de São Paulo, por meio de entrevista semiestruturada com questões abertas, entre junho e agosto de 2010. Na busca do significado desta vivência, mantivemos uma atitude fenomenológica na análise, o que propiciou desvelar o fenômeno "buscar viver apesar de se sentir preso em uma gaiola". Os pacientes apontam que é o desejo pessoal e apoio de outras pessoas que propiciam a reorganização de suas vidas, apesar dos inúmeros desafios que precisam superar para adaptarem-se ao fixador acoplado ao seu corpo, do medo que sentem em relação ao futuro e das dúvidas quanto ao tratamento.

The present study is aimed to understand the meaning of living with an external fixation device forgrade III open fractures of the lower limbs from the perspective of the patient.The data were collected with six young adults who were under going out patient orthopedic treatment in a public hospital in the city of SãoPaulo, through semi-structured interviews with open questions, between Juneand August 2010. Seeking to understand the meaning of this experience,we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon"try to live in spiteof feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

El objetivo de este estudio fue comprender el significado de vivir con fijación externa para las fracturas abiertas de grado III de los miembros inferiores bajo la mirada del paciente. Los datos fueron recogidos con seis jóvenes adultos que no habían recibido tratamiento ortopédico de ambulatorio en un hospital público en la ciudad de SãoPaulo, a través de entrevistas semi estructuradas con preguntas abiertas,entre junio y agosto de 2010. En búsqueda del significado de esta experiencia que hemos mantenido una actitud de análisis fenomenológico, lo que llevó a revelar el fenómeno"tratan de vivir a pesarde sentirse atrapado en una jaula." Los pacientes indican que es el deseo y el apoyo de otros que están a favor de la reorganización de la vida personal, apesar de los numerosos desafíos que se deben superar para adaptarse a la sujeción acoplada a su cuerpo,el miedo que sienten sobre el futuro y las dudas en el tratamiento.