Infrapopliteal Bypass In Patients On Dialysis: Patency And Survival.

INTRODUCTION: Portugal has one of the highest prevalence of patients on a regular dialysis program. This population has a higher incidence of peripheral arterial disease with higher rates of postoperative morbidity and mortality. Our goal was to compare outcomes between dialysis and non-dialysis patients with chronic limb threatening ischemia (CLTI) submitted to infrapopliteal bypass. MATERIALS AND METHODS: A retrospective single-center study of infrapopliteal bypass for CLTI was performed between 2012 and 2019. Patients were divided in two groups based on dialysis status (group 1 incorporated patients on dialysis). Primary end point was 1-year freedom from CLTI. Secondary end points were limb-salvage, survival and primary (PP) and tertiary patency (TP) rates at 3 years of follow-up. RESULTS: A total of 352 infrapopliteal bypasses were performed in 310 patients with CLTI. Fourteen percent of the revascularizations were performed on dialysis patients (48/352). Median age was 73 years (interquartile range - IQR 15) and 74% (259/352) were male. Median follow-up was 26 months (IQR 42). Overall, 92% (325/352) had tissue loss and 44% (154/352) had some degree of infection. The majority of revascularization procedures were performed with vein grafts (61%, 214/352). The 30-day mortality was 4% (11/310), with no difference between groups (p = 0.627). Kaplan-Meier analysis showed no difference between groups regarding freedom from CLTI (76% vs. 79%; HR 0.96, CI 0.65-1.44, p=0.857), limb-salvage (70% vs. 82%; HR 1.40, CI 0.71-2.78, p=0.327) and survival (62% vs. 64%; HR 1.08, CI 0.60-1.94, p=0.799). PP rates were 39% in group 1 and 64% in group 2 (HR 1.71, CI 1.05-2.79, p=0.030). TP rates were not different between groups (57% and 78%; HR 1.79, CI 0.92-3.47, p=0.082). CONCLUSION: Infrapopliteal bypass for CLTI, on dialysis patients, resulted in lower PP rates. No differences were observed in freedom from CLTI, TP, limb salvage and survival.

Impact of Extraction Methods and Transportation Conditions on Lipid Profiles of Bovine Oocytes.

Lipids play numerous pivotal physiological roles in mammalian reproduction, being indispensable for oocyte competence acquisition and post-fertilization embryonic development. Profiling lipids in minute samples, such as oocytes, presents challenges but has been accomplished through mass spectrometry technologies like Multiple Reaction Monitoring (MRM) profiling. With the dual objectives of simplifying workflow and examining the influence of preanalytical conditions, we assessed whether transportation at room temperature affects the lipid profile of bovine oocytes. To this end, samples were prepared using either monophasic (methanol only) or biphasic liquid extraction protocols (Bligh & Dyer method) and transported either on dry ice or at room temperature inside sealed-vacuum packages to prevent lipid oxidation. Subsequently, employing a comprehensive method, we screened a list of 316 MRMs from 10 different lipid subclasses in oocyte lipid extracts. Principal Component Analysis (PCA) revealed similar lipid profiles concerning temperature during transportation, whereas clear differentiation among samples was observed based on the lipid extraction method. Univariate analysis indicated that the one-phase methanol extraction resulted in higher relative abundances of phospholipids, except for phosphatidylserines. Conversely, the Bligh & Dyer extraction favored the detection of neutral intracellular lipids (triacylglycerols, free fatty acids, cholesteryl esters, and acyl-carnitines). Consequently, lipid recovery was directly correlated with the polarity of lipid class and the extraction method. Regarding transportation temperature, phosphatidylethanolamine, triacylglycerol, and free fatty acids exhibited lower abundances when samples were transported at room temperature. Based on multivariate and univariate analyses, we conclude that if samples undergo the same lipid extraction protocol and are transported in the same batch at room temperature inside vacuum-sealed bags, it is feasible to analyze lipid extracts of bovine oocytes and still obtain informative lipid profiling results.

Integrated Proteomics Characterization of NLRP3 Inflammasome Inhibitor MCC950 in Monocytic Cell Line Confirms Direct MCC950 Engagement with Endogenous NLRP3.

Inhibition of the NLRP3 inflammasome is a promising strategy for the development of new treatments for inflammatory diseases. MCC950 is a potent and selective small-molecule inhibitor of the NLRP3 pathway and has been validated in numerous species and disease models. Although the capacity of MCC950 to block NLRP3 signaling is well-established, it is still critical to identify the mechanism of action and molecular targets of MCC950 to inform and derisk drug development. Quantitative proteomics performed in disease-relevant systems provides a powerful method to study both direct and indirect pharmacological responses to small molecules to elucidate the mechanism of action and confirm target engagement. A comprehensive target deconvolution campaign requires the use of complementary chemical biology techniques. Here we applied two orthogonal chemical biology techniques: compressed Cellular Thermal Shift Assay (CETSA) and photoaffinity labeling chemoproteomics, performed under biologically relevant conditions with LPS-primed THP-1 cells, thereby deconvoluting, for the first time, the molecular targets of MCC950 using chemical biology techniques. In-cell chemoproteomics with inlysate CETSA confirmed the suspected mechanism as the disruption of inflammasome formation via NLRP3. Further cCETSA (c indicates compressed) in live cells mapped the stabilization of NLRP3 inflammasome pathway proteins, highlighting modulation of the targeted pathway. This is the first evidence of direct MCC950 engagement with endogenous NLRP3 in a human macrophage cellular system using discovery proteomics chemical biology techniques, providing critical information for inflammasome studies.

Photodynamic therapy adjuvant to non-surgical periodontal therapy: Systematic review of randomized clinical trials.

OBJECTIVES: To systematically evaluate randomised controlled trials (RCTs) on whether adjuvant application of antimicrobial photodynamic therapy (aPDT) through the technique of irradiation in the external region of the periodontal pocket with optic-fibre tip offers benefits to scaling and root planning (SRP). METHODS: Five databases were searched by two independent reviewers according to pre-specified eligibility criteria up to April 2023. No restrictions regarding date of publication, language and minimum follow-up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and Grading of Recommendations, Assessment, Development and Evaluation for assessing the certainty of evidence. RESULTS: A total of 1388 publications were identified and reviewed for eligibility. Four of them fulfilled the inclusion criteria. The sample consisted of a total of 83 patients with periodontitis. In these, 330 periodontal sites were evaluated. The clinical findings of the majority of the included studies demonstrated that patients who received the association of aPDT + RAR with the protocol evaluated here, obtained clinical results similar to patients who received only the SRP alone. In none of the evaluated RCTs, clinical advantages were observed that would categorise this aPDT protocol as superior to conventional treatment. CONCLUSION: Applying aPDT after SRP with external irradiation of the periodontal pocket does not seem to result in any clinical benefit compared to the use of SRP alone in patients with periodontitis.

Heparin-Bonded Expanded Polytetrafluoroethylene Is a Solution for Infrapopliteal Revascularization in the Absence of an Adequate Autologous Vein Graft.

BACKGROUND: To analyze the outcomes of heparin-bonded expanded polytetrafluoroethylene (HePTFE) graft as an alternative conduit in infrapopliteal revascularization of chronic limb-threatening ischemia (CLTI) in the absence of an autologous vein conduit. METHODS: A single-center retrospective analysis of patients with CLTI submitted to infrapopliteal bypasses with autologous vein graft (VEIN group) or HePTFE graft (HePTFE group) was implemented. Primary end points were freedom from CLTI at 12 months and recurrence of CLTI at 3 years. Secondary end points included freedom from major amputation, amputation-free survival (AFS), survival, and primary (PP) and secondary patency (SP) rates at 3 years of follow-up. RESULTS: A total of 348 limbs submitted to infrapopliteal bypasses, 214 with venous graft and 134 with HePTFE graft, were followed-up for a median of 25 months. Most patients of the HePTFE group were male (69%), with a median age of 76 years (interquartile range [IQR] 15). Fifty-nine percent of the limbs of the HePTFE group had Wound grade ≥2, being 46% of them infected. Eighty-eight percent were GLASS stage III. Freedom from CLTI was not significantly different between HePTFE and VEIN groups (75% vs. 84%, adjusted hazard ratio [aHR] 0.88, confidence interval [CI] 0.66-1.18, P = 0.401). Recurrence of CLTI was higher in the HePTFE group (42% vs.18% at 3 years; aHR 2.82, CI 1.59-5.00, P < 0.001). The VEIN group achieved higher rates of freedom from major amputation (87% vs.69% at 3 years; aHR 2.21, CI 1.31-3.75, P = 0.003) and AFS (59% vs. 37% at 3 years; aHR 1.39, CI 1.02-1.88, P = 0.036), but no significance in survival (aHR 1.10, CI 0.72-1.66, P = 0.667). Patency rates were inferior in the HePTFE group, with 2-year PP and SP rates of 52% vs. 74%, and 76% vs. 90%, respectively (PP: aHR 1.70, CI 1.11-2.59, P = 0.014; SP: aHR 2.51, CI 1.42-4.42, P = 0.001). CONCLUSIONS: Infrapopliteal bypass with autologous vein graft is the gold standard to treat CLTI limbs. HePTFE graft should be regarded as an alternative for complex infrapopliteal revascularization when lacking an autologous vein conduct.

Comparing follow-up of patients with vitamin K antagonists in a health center: pre- and post-COVID-19 pandemic / Comparação do seguimento de doentes hipocoagulados com antagonistas da vitamina K numa unidade de saúde: pré e pós pandemia COVID-19

Introduction and objectives: During the COVID-19 pandemic, the follow-up of patients treated with vitamin K antagonists (VKAs) may have been affected. This study aims to compare how these patients were monitored pre- and post-COVID-19 pandemic and understand the impact of non-face-to-face appointments on their follow-up. Methods: We conducted a retrospective cohort study in a Portuguese Health Center. The study included patients treated with VKAs and followed at the Health Center for international normalized ratio (INR) monitoring between March 2019 and March 2021. Data collected: sex, age, type of VKA; INR; date of INR assessment, type of appointment (face-to-face or phone/e-mail). Rosendaal's method was used to calculate pre-COVID-19 and post-COVID-19 time in therapeutic range (TTR). Good TTR control was defined if values ≥ 70%. Results: 44 patients were included. The mean TTR in the pre-COVID-19 period was 64.55% (95% CI: 58.10 - 71.00%). The post-COVID-19 mean was slightly higher (+ 2.26%), 66.81% (95% CI: 59.66 - 73.97%), but the difference was not statistically significant (p = 0.576). The use of non-face-to-face appointments did not contribute to worsening post-pandemic TTR, show-ing no lower follow-up than during pre-pandemic period in which all contacts were face-to-face [CI (95%) -0.397 - 0.196 for a reference range -0.489 - 0.693]. Conclusions: The TTR value in both periods was similar and lower than the value defined for effective hypocoagulation. The use of non-face-to-face consultation in the post-COVID-19 period does not seem to have influenced the quality of hypocoagulation (AU).

Introdução e objetivos: Durante a pandemia COVID-19 o acompanhamento de doentes medicados com antagonistas da vitamina K (AVKs) pode ter sido afetado. Este estudo pretende comparar a forma como estes doentes foram monitorizados antes e depois da pandemia COVID-19 e compreender o impacto da consulta não presencial no seu seguimento. Métodos: Estudo de coorte retrospetivo num Centro de Saúde em Portugal. O estudo incluiu doentes tratados com AVKs e seguidos no Centro de Saúde para monitorização do International Normalized Ratio(INR) entre março de 2019 e março de 2021. Dados recolhidos: sexo, idade, tipo de AVK; INR; data da avaliação do INR, tipo de consulta (presencial ou por telefone/e-mail). Foi utilizado o método de interpolação linear de Rosendaal para calcular o tempo em intervalo terapêutico (TTR) pré- e pós-COVID-19. Foi definido um bom controle se valores de TTR ≥ 70%. Resultados: Foram incluídos 44 doentes. A média de TTR no período pré-COVID-19 foi de 64,55% (95% IC: 58,10 - 71,00%). A média pós-COVID-19 foi ligeiramente superior (+ 2,26%), 66,81% (95% IC: 59,66 - 73,97%), mas a diferença não foi estatisticamente significativa (p = 0,576). A utilização da consulta não presencial não contribuiu para o agravamento do TTR no período pós-pandemia, não mostrando um seguimento inferior ao do período pré-pandemia em que todos os contatos foram presenciais [IC (95%) -0,397 - 0,196 para um intervalo de referência -0,489 - 0,693]. Conclusões: O valor de TTR em ambos os períodos foi semelhante e inferior ao valor definido para hipocoagulação eficaz. A utilização da consulta não presencial no período pós-COVID-19 não parece ter influenciado a qualidade da hipocoagulação (AU).

Prognostic Factors and Markers in Non-Small Cell Lung Cancer: Recent Progress and Future Challenges.

Lung cancer is a highly aggressive neoplasm and, despite the development of recent therapies, tumor progression and recurrence following the initial response remains unsolved. Several questions remain unanswered about non-small cell lung cancer (NSCLC): (1) Which patients will actually benefit from therapy? (2) What are the predictive factors of response to MAbs and TKIs? (3) What are the best combination strategies with conventional treatments or new antineoplastic drugs? To answer these questions, an integrative literature review was carried out, searching articles in PUBMED, NCBI-PMC, Google Academic, and others. Here, we will examine the molecular genetics of lung cancer, emphasizing NSCLC, and delineate the primary categories of inhibitors based on their molecular targets, alongside the main treatment alternatives depending on the type of acquired resistance. We highlighted new therapies based on epigenetic information and a single-cell approach as a potential source of new biomarkers. The current and future of NSCLC management hinges upon genotyping correct prognostic markers, as well as on the evolution of precision medicine, which guarantees a tailored drug combination with precise targeting.

Effect of different pre-treatments on the redispersion capacity of spray-dried microfibrillated cellulose: Elaboration and characterization of biofilms.

This study aimed to evaluate the influence of the addition of the cationic surfactant cetyltrimethylammonium bromide (CTAB) in microfibrillated cellulose (MFC/CNFs) suspensions submitted to different pretreatments to produce redispersible spray-dried (SD) MFC/CNFs. Suspensions pretreated with 5 % and 10 % sodium silicate and oxidized with 2,2,6,6,-tetramethylpiperidinyl-1-oxyl (TEMPO) were modified with CTAB surfactant and subsequently dried by SD. The SD-MFC/CNFs aggregates were redispersed by ultrasound to produce cellulosic films by the casting method. In summary, the results demonstrated that the addition of CTAB surfactant to the TEMPO-oxidized suspension was critical to achieving the most effective redispersion. The experimental results obtained using micrographs, optical (UV-Vis), mechanical, water vapor barrier properties, and the quality index confirmed that the addition of CTAB to the TEMPO-oxidized suspension favored the redispersion of spray-dried aggregates, development of cellulosic films with attractive properties, offering possibilities for the elaboration of new products, for example, in the production of bionanocomposites with higher mechanical performance. This research brings interesting insights into the redispersion and application of SD-MFC/CNFs aggregates, strengthening the commercialization of MFC/CNFs for industrial use.

Biogas production from malt bagasse from craft beer industry: kinetic modeling and process simulation.

In this work, biogas was synthesized from malt enriched-craft beer bagasse with the objective to generate clean energy. Thus, a kinetic model based on thermodynamic parameters was proposed to represent the process with coefficient determination (R2) of 0.82. A bench-top biodigester of 2.0 × 10-3 m3 was built in glass, and equipped with sensors to measure pressure, temperature, and methane concentration. The inoculum selected for the anaerobic digestion was the granular sludge, and malt bagasse was used as substrate. Data were fitted to a pseudo-first-order model for the formation of methane gas using the Arrehnius equation as basis. For the simulations of biogas production, the Aspen Plus™ software was used. Results from 23 factorial design experiments evidenced that equipment was efficient, and the craft beer bagasse showed great biogas production, with nearly 95% of methane yield. The temperature was the variable that showed most influence in the process. Moreover, the system has a potential for the generation of 10.1 kWh of clean energy. Kinetic constant rate for methane production was 5.42 × 10-7 s-1 and activation energy 8.25 kJ mol-1. A statistical analysis using a math software was performed and evidenced that the temperature played a major role in the biomethane conversion. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-023-01715-7.

An Epithelioid Hemangioma Camouflaged As Radial Aneurysm.

Epithelioid hemangioma (EH) is an uncommon benign vascular lesion usually present as subcutaneous nodules in the head and neck area. Sometimes, these lesions can occur in the peripheral arteries, and when they do, they can be mistaken for aneurysmal dilatations of that respective vessel. We report a case of a 43-year-old male who underwent surgical recession of a radial aneurysm, which after anatomopathological examination, revealed an EH.

Effects of solid retention time and exposure mode to electric current on Remazol Brilliant Violet removal in an electro-membrane bioreactor.

The performance of an electrochemically assisted anoxic-oxic membrane bioreactor (A/O-eMBR) was assessed as an alternative for azo dye (Remazol Brilhant Violet (RBV)) removal from simulated textile wastewater. The A/O-eMBR was operated under three experimental conditions (runs I, II, and III), in which different solids retention time (SRT) (45 and 20 d) and exposure mode to electric current (6'ON/30'OFF and 6'ON/12'OFF) were assessed. The reactor exhibited excellent decolorization performance for all runs, with average dye removal efficiency ranging from 94.3 to 98.2%. Activity batch assays showed that the dye removal rate (DRR) decreased from 16.8 to 10.2 mg RBV L-1 h-1 when the SRT was reduced from 45 to 20 d, likely attributed to the lower biomass content under lower sludge age. At the electric current exposure mode of 6' ON/12'OFF, a more substantial decrease of DRR to 1.5 mg RBV L-1 h-1 was noticed, suggesting a possible inhibitory effect on dye removal via biodegradation. By reducing the SRT to 20 d, a worse mixed liquor filterability condition was observed, with a membrane fouling rate (MFR) of 0.979 kPa d-1. In contrast, using the electric current exposure mode of 6'ON/12'OFF resulted in lower membrane fouling propensity, with an MFR of 0.333 kPa d-1. A more attractive cost-benefit ratio for dye removal was obtained using the exposure mode of 6'ON/30'OFF, for which the energy demand was estimated at 21.9-22.6 kWh kg dye-1 removed, almost two times lower than that observed for the mode of 6'ON/12'OFF.

Embarque na residência integrada em saúde: relato de experiências com ênfase em saúde coletiva / Boarding on the integrated health residence: report of experiences with emphasis on public health / Abordaje de la residencia sanitaria integrada: relato de experiencias con énfasis en salud pública

Este trabalho tem o objetivo de relatar a experiência de imersão na especialização com caráter de residência integrada com ênfase em Saúde Coletiva. Trata- se de um estudo descritivo, qualitativo, utilizando-se como referencial teórico para descrição a observação participante, memória afetiva, diário de bordo e da textualização. Foi desenvolvido na Residência Integrada em Saúde, da Escola de Saúde Pública do Estado do Ceará, ênfase em Saúde Coletiva, no período de dois anos, em Fortaleza, Ceará. Os cenários de prática foram setores relacionados à Atenção Primária à Saúde, Vigilância Epidemiológica, Sanitária e Ambiental, Controle de Endemias e Zoonoses, Imunização, além dos espaços de gestão, assistência e controle social. A imersão na especialização em caráter de residência viabilizou ferramentas para a vivência, por meio da interprofissionalidade e integração contínuas, e da realização das atividades, circulação de informações, compreensão das experiências, entendimento de macroprocessos, políticas e indicadores. Rodas de Campo e de Equipe viabilizaram o aprofundamento das temáticas administrativa, formativa, teórica e terapêutica. Percebeu-se resistência e desejo de remodelações, mediante inovação e diálogo intersetorial. A relação entre as categorias profissionais e ser sanitarista foi desafiadora. Oportunizou-se, também, habilidades de gestão, autonomia e governança, com pluralidade formativa e riqueza de atuação. A vivência favoreceu a percepção do programa de residência como processo formativo plural e significativo. O elemento político se destacou como base para a formação dos residentes e fortalecimento do sistema de saúde, e a residência integrada em saúde, como modalidade diferenciada de formação, com desafios e potencialidades.

The object of this study was to report the experience of immersion in the specialization as an integrated residency with emphasis on Public Health. A descriptive, qualitative study, of the experience report type, using participant observation, affective memory, logbook and textualization as theoretical references for description. It was developed in the Integrated Residency in Health, of the School of Public Health. emphasis on Public Health, during two years, in Fortaleza, Ceará, Brazil. The practice scenarios were sectors related to Primary Health Care, Epidemiological, Sanitary and Environmental Surveillance, Endemic and Zoonosis Control, Immunization, in addition to management, assistance and social control spaces. The immersion in the specialization in a residency character has enabled tools for the experience, through continuous interprofessionalism and integration, and the realization of activities, circulation of information, understanding of experiences, understanding of macro processes, policies and indicators. Field and team meetings made it possible to deepen the administrative, formative, theoretical, and therapeutic themes. Resistance and a desire for remodeling was perceived, through innovation and intersectoral dialogue. The relationship between the professional categories and being a sanitarian was challenging. It also provided opportunities for management skills, autonomy, and governance, with formative plurality and richness of action. The experience favored the perception of the residency program as a plural and significant formative process. The political element stood out as the basis for training residents and strengthening the health system, and the integrated health residency as a differentiated training modality, with challenges and potentialities.

El objeto de este estudio fue relatar la experiencia de inmersión en la especialización como residencia integrada con énfasis en Salud Pública. Estudio descriptivo, cualitativo, del tipo relato de experiencias, utilizando la observación participante, la memoria afectiva, la bitácora y la textualización como referentes teóricos para la descripción. Se desarrolló en la Residencia Integrada en Salud, de la Escuela de Salud Pública. énfasis en Salud Pública, durante dos años, en Fortaleza, Ceará, Brasil. Los escenarios de la práctica fueron sectores relacionados con la Atención Primaria de Salud, Vigilancia Epidemiológica, Sanitaria y Ambiental, Control de Endemias y Zoonosis, Inmunización, además de espacios de gestión, asistencia y control social. La inmersión en la especialización en carácter de residencia ha posibilitado herramientas para la experiencia, a través de la continua interprofesionalidad e integración, y la realización de actividades, circulación de información, comprensión de experiencias, entendimiento de macro procesos, políticas e indicadores. Reuniones de campo y de equipo posibilitaron la profundización de los temas administrativos, formativos, teóricos y terapéuticos. Se percibieron resistencias y deseos de remodelación, a través de la innovación y el diálogo intersectorial. La relación entre las categorías profesionales y el ser sanitario fue desafiante. También proporcionó oportunidades para la capacidad de gestión, autonomía y gobernanza, con pluralidad formativa y riqueza de acción. La experiencia favoreció la percepción del programa de residencia como un proceso formativo plural y significativo. Se destacó el elemento político como base para la formación de residentes y fortalecimiento del sistema de salud, y la residencia integrada en salud como modalidad formativa diferenciada, con desafíos y potencialidades.

Effect of lipid extraction and room temperature transportation of bovine oocytes determined by MRM profiling.

Lipids play many important physiological roles in mammalian reproduction, being essential for the acquisition of oocyte competence and post-fertilization embryonic development. Lipid profiling in samples of minute size, such as oocytes, is challenging but has been achieved by mass spectrometry technologies such as multiple reaction monitoring (MRM) profiling. With the goals of further simplifying sample workflow and investigating the influence of pre-analytical conditions, we have evaluated how different extraction methods and transportation of lipid extracts in vacuum and at room temperature impacted the lipid profile of bovine oocytes. Using a comprehensive method, 316 MRMs associated with lipids of 10 different classes were screened in oocyte lipid extracts prepared by 2 extraction methods (one-step methanol addition or Bligh and Dyer) and transporting them in dry ice or at room temperature inside vacuum packages. No changes in the multivariate analysis (PCA) were noticeable due to transportation temperature, while lipid profiles were more affected by the lipid extraction protocol. Sample extraction using pure methanol favored the detection of phospholipids uniformly, while Bligh and Dyer favored the detection of neutral intracellular lipids. Triacylglycerol lipids and free fatty acids yielded decreased abundances when samples were transported at room temperature. We conclude that if samples are submitted to the same lipid extraction protocol and same transportation batch at room temperature coupled with vacuum conditions it is possible to analyze lipid extracts of bovine oocytes and still obtain informative lipid profiling results.

Aprendizagem significativa na educação em enfermagem: uma revisão integrativa / Meaningful learning in nursing education: an integrative review / Aprendizaje significativo en la formación de enfermería: una revisión integrativa

Objetivo: Analisar a produção científica acerca das estratégias educativas, baseadas em evidências, utilizadas no processo de ensino aprendizagem em enfermagem à luz da abordagem da aprendizagem significativa. Método: Revisão integrativa desenvolvida de acordo com as etapas: identificação do tema e seleção da hipótese de pesquisa; estabelecimento dos critérios de elegibilidade; identificação dos estudos nas bases científicas/categorização dos estudos; avaliação dos estudos selecionados; análise crítica e interpretação dos resultados; apresentação dos dados na estrutura da revisão integrativa. Resultados: Diferentes estratégias educativas baseadas na aprendizagem significativa foram identificadas tais como: mapa conceitual, estudo de caso, uso de simulador, cursos on-line e jogos. Como principais resultados das intervenções, observou-se a promoção da aprendizagem significativa e o desenvolvimento do raciocínio reflexivo e crítico em estudantes e profissionais de enfermagem, atuando como sujeitos de sua própria práxis. Conclusão: A aprendizagem significativa é uma linha pedagógica fundamental, devendo ser inserida no processo de educação em diversas áreas do saber. Dessa maneira, foi possível identificar que a mesma ancorou estratégias de ensino que se mostraram eficazes, com destaque para o uso de mapas conceituais e as tecnologias educacionais digitais.

Objective: To analyze the scientific production about educational strategies, based on evidence, used in the teaching-learning process in nursing in the light of the meaningful learning approach. Method: Integrative review developed according to the steps: identification of the theme and selection of the research hypothesis; establishment of eligibility criteria; identification of studies in scientific bases/categorization of studies; evaluation of selected studies; critical analysis and interpretation of results; presentation of data in the framework of the integrative review. Results: Different educational strategies based on meaningful learning were identified, such as: conceptual map, case study, use of simulator, online courses and games. As main results of the interventions, it was observed the promotion of meaningful learning and the development of reflective and critical reasoning in students and nursing professionals, acting as subjects of their own praxis. Conclusion: Meaningful learning is a fundamental pedagogical line and should be inserted in the education process in several areas of knowledge. In this way, it was possible to identify that it anchored teaching strategies that proved to be effective, with emphasis on the use of concept maps and digital educational technologies.

Objetivo: Analizar la producción científica sobre estrategias educativas basadas en la evidencia utilizadas en el proceso de enseñanza-aprendizaje en enfermería a la luz del enfoque del aprendizaje significativo. Método: Revisión integrativa desarrollada de acuerdo con los siguientes pasos: identificación del tema y selección de la hipótesis de investigación; establecimiento de criterios de elegibilidad; identificación de estudios en bases de datos científicas/categorización de estudios; evaluación de los estudios seleccionados; análisis crítico e interpretación de los resultados; presentación de los datos en la estructura de revisión integrativa. Resultados: Se identificaron distintas estrategias educativas basadas en el aprendizaje significativo como: mapa conceptual, estudio de casos, uso de simulador, cursos online y juegos. Los principales resultados de las intervenciones fueron la promoción del aprendizaje significativo y el desarrollo del pensamiento reflexivo y crítico en estudiantes y profesionales de enfermería, actuando como sujetos de su propia praxis. Conclusión: El aprendizaje significativo es una línea pedagógica fundamental y debe insertarse en el proceso educativo en diversas áreas del conocimiento. Así, fue posible identificar que ancló estrategias de enseñanza que se mostraron eficaces, con énfasis en el uso de mapas conceptuales y tecnologías educativas digitales.

Pectin-based color indicator films incorporated with spray-dried Hibiscus extract microparticles.

Colorimetric films incorporated with anthocyanins as an indicator for freshness monitoring have aroused growing interest recently. The pH-sensing colorimetric film were developed based on pectin (HM), containing aqueous hibiscus extract microparticles (HAE). HAE microparticles were obtained by spray drying with different wall materials (Inulin -IN, maltodextrin- MD and their combination). The films were obtained on large scale by continuous casting. These films were characterized for physicochemical analysis, morphological structure, thermal and barrier properties, antioxidant activity, and color change at different pH. The addition of HAE microparticles caused relevant changes to HM-based films, such as in mechanical behavior and improved barrier property (11-22% WVTR reduction) depending on the type of wall material used and the concentration added. It was verified with the thermal stability of films, with a slight increase being observed. The color variation of smart films was entirely pH-dependent. Overall, the proposed color indicator films showed unique features and functionalities and could be used as an alternative natural pH indicator in smart packaging systems.

Evaluation of Queen Palm residues and kraft lignin in the production of biofuels using densification and slow pyrolysis technology.

This study aims to enhance the energy use of two products of industry - Queen Palm residue and kraft lignin (KF) - through the combination of two technologies - briquetting and slow pyrolysis. The addition of 20% KF provided briquettes with higher physical, energy, and mechanical properties. The yields of the pyrolysis products were affected by both the pyrolysis temperature and the addition of KF. In the bio-oil, the presence of phenols, methyl phenols, and methoxy phenols was highlighted; these compounds were present in greater quantities in the treatments with KF. It is concluded that combining the briquetting and pyrolysis processes produces both energy and economic benefits because it is possible to transport lighter loads with the same amount of energy per volume. Under the briquetting conditions adopted in this study, the addition of KF as a binder is necessary because this results in briquettes with better physical, energy and mechanical properties.

Effects of Photodynamic Therapy with Laser Photobiomodulation as an Adjunct to Scaling and Root Planing: Systematic Review / Efeitos da Terapia Fotodinâmica com Fotobiomodulação Laser Adjuvante a Raspagem e Alisamento Radicular: Revisão Sistemática

Scaling and root planing is the gold standard procedure in the periodontal disease treatment. Although this therapy has the ability to reduce or eliminate periodontopathogens mthrough periodontal instrumentation, sometimes the response to treatment may not promote the complete eradication of pathogens, affecting the healing process and leading to the presence of residual periodontal pockets. The aim of this study was to analyze the effectiveness of photodinamic therapy with laser photobiomodulation and as an adjunct to scaling and root planing (having as a conductive agent a fiber optic tip radiating inside the periodontal pocket), compared to scaling and root planing alone in patients with periodontitis on randomized trials. This systematic review was carried out complying with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta Analyses. The databases used were Pubmed, Lilacs, Biblioteca Virtual em Saúde - Odontologia and Medline. "Periodontal Disease" OR "Periodontal Treatment" AND m"Photodinamic Theraphy" were the descriptors used. A total of five articles were included. Two studies have shown superior results in relation to the referred association; a study indicated benefits in biochemical and/or microbiological aspects; it suggests, however, that clinical relevance needs to be better evaluated; two studies did not reveal benefits that categorize photodynamic therapy + scaling and root planning as superior to conventional treatment. The association in question, when well standardized and performed, can result in promising responses in the control of periodontal disease; however, the clinical benefits that demonstrate its superiority will certainly be subject to new researches. (AU)

A raspagem e alisamento radicular é o procedimento padrão-ouro no tratamento da doença periodontal. Embora essa terapia seja capaz de reduzir ou eliminar os periodontopatógenos por meio da instrumentação periodontal, algumas vezes a resposta ao tratamento pode não promover completa erradicação dos patógenos, afetando assim, o processo de cicatrização e levando à presença de bolsas periodontais residuais. O objetivo do presente estudo foi analisar a eficácia da terapia fotodinâmica com fotobiomodulação laser adjuvante a raspagem e alisamento radicular (tendo como agente condutor uma ponta de fibra óptica que irradia o interior da bolsa periodontal), em comparação com a raspagem e alisamento radicular isoladamente em pacientes com periodontite, avaliados em estudos clínicos randomizados. Esta revisão sistemática foi realizada de acordo com as recomendações Principais Itens para Relatar Revisões sistemáticas e Meta-análises. As bases de dados utilizadas foram Pubmed, Lilacs, Biblioteca Virtual em Saúde - Odontologia e Medline. "Doença periodontal" OR "Tratamento periodontal" AND "Terapia fotodinâmica" foram os descritores utilizados. Um total de cinco artigos foram incluídos. Dois estudos mostraram resultados superiores em relação à referida associação; um estudo indicou benefícios nos aspectos bioquímicos e/ou microbiológicos; sugere, no entanto, que a relevância clínica precisa ser melhor avaliada; dois estudos não revelaram benefícios que categorizassem a terapia fotodinâmica + raspagem e alisamento radicular como superiores ao tratamento convencional. A associação em questão, quando bem padronizada e realizada, pode resultar em respostas promissoras no controle da doença periodontal; entretanto, os benefícios clínicos que demonstram sua superioridade certamente serão alvo de novas pesquisas. (AU)

Evaluation of global limb anatomic staging system for patients with chronic limb-threatening ischemia treated with autogenous bypass grafts.

OBJECTIVE: We evaluated the relationship of the global limb anatomic staging system (GLASS) stage with the clinical outcomes for patients with chronic limb-threatening ischemia (CLTI) who had undergone distal bypass with vein grafting. METHODS: We performed a single-center, retrospective analysis of patients with CLTI who had undergone distal bypass with vein grafting from January 2012 to December 2019. The primary end point was freedom from CLTI, including amputation-free survival, complete wound healing, and no ischemic rest pain. The secondary end points included a composite outcome of recurrence (patients who had achieved freedom from CLTI but had developed a new wound or ischemic rest pain), major limb amputation, amputation free-survival, overall survival, major adverse limb events, limb-based patency, and primary and secondary patency rates. RESULTS: A total of 190 patients had undergone 211 distal bypasses with a median follow-up of 30 months. Of these patients, 80% had had diabetes or end-stage renal disease requiring dialysis. Most patients (63%) had experienced major or extensive tissue loss (WIfI [wound, ischemia, foot infection] wound class ≥2), and more than one half of these had had some degree of infection of the foot. A severe anatomic pattern (GLASS stage III) was predominant, with a prevalence of 78%. No significant differences were found between GLASS stage I and II and GLASS stage III groups for all the outcomes analyzed. Approximately 80% of the 211 revascularized limbs were free of CLTI at 12 months after treatment. At 4 years of follow-up, we observed that 25% of the patients had had CLTI recurrence, 83% were free from major amputation, and 61% were free from major adverse limb events. Limb-based patency, primary patency, and secondary patency were 79%, 80%, and 93% at 1 year and 64%, 65%, and 81% at 4 years, respectively. CONCLUSIONS: The GLASS stage was not related to patency or the clinical outcomes after distal bypass with vein grafting. Distal open revascularization resulted in excellent rates of freedom from CLTI with low rates of CLTI recurrence, two key time-integrated outcomes of clinical disease severity for patients with CLTI.

Plano de parto no pré-natal: conhecimento dos enfermeiros da atenção primaria à saúde / Pre-natal delivery plan: nurses' knowledge of primary health care / Plan de parto prenatal: conocimientos de las enfermeras sobre atención primaria de la salud

Introdução: É fundamental implementar medidas direcionadas a assegurar a melhoria da cobertura e da qualidade do acompanhamento do pré-natal, da assistência ao parto e puerpério e da assistência à criança. Objetivos: Identificar o conhecimento dos enfermeiros da Atenção Primária à Saúde sobre o plano de parto; realizar ação educativa com os enfermeiros da Atenção Primária à Saúde acerca do plano de parto e identificar seu impacto; informar e destacar junto aos enfermeiros da Atenção Primária à Saúde a importância e a abordagem do plano de parto durante o Pré-Natal. Método: Trata-se de um estudo, descritivo, exploratório de abordagem mista. O Município de Catanduva tem cerca de 121.862 habitantes e 23 unidades de Saúde para atendimento em Atenção Básica, com 46 enfermeiras atuando diretamente no acompanhamento do Pré-Natal e nas ações educativas com as gestantes. Resultados: Nota-se defasagem quanto ao conhecimento e aplicação do instrumento referente ao plano de parto pelos enfermeiros da Atenção Primária à Saúde, evidenciando a importância da criação de treinamentos e protocolos dentro dessa temática. Conclusão: Com o desenvolvimento do estudo, foi possível concluir o quão importante é o Plano de Parto, tanto para a gestante no âmbito de expressar suas vontades, desejos, sanar suas dúvidas e medos, como também é fundamental para o profissional inserido na assistência, já que ele é um documento escrito e de caráter legal, o que o torna meio de respaldo para possíveis contratempos.(AU)

Introduction: It is essential to implement measures aimed at ensuring improved coverage and quality of prenatal care, childbirth and puerperium care and child care. Objectives: To identify the knowledge of Primary Health Care nurses about the birth plan; to carry out educational action with Primary Health Care nurses about the birth plan and to identify its impact; To inform and highlight the importance and approach of the birth plan during the Prenatal Care with the nurses of the Primary Health Care. Method: This is a descriptive, exploratory study with a mixed approach. The city of Catanduva has about 121,862 inhabitants and 23 health units for primary care, with 46 nurses working directly in the monitoring of prenatal care and educational actions with pregnant women. Results: There is a lag in knowledge and application of the instrument related to the birth plan by nurses in Primary Health Care, showing the importance of creating training and protocols within this theme. Conclusion: With the development of the study, it was possible to conclude how important is the Birth Plan, both for the pregnant woman in the context of expressing her wishes, desires, remedy her doubts and fears, as well as is fundamental for the professional inserted in the assistance, since it is a written and legal document, which makes it a means of support for possible setbacks.(AU)

Introducción: Es fundamental implementar medidas encaminadas a garantizar una mejor cobertura y calidad de la atención prenatal, atención al parto y puerperio y atención al niño. Objetivos: Identificar el conocimiento de los enfermeros de la Atención Primaria de Salud (APS) sobre el plan de parto; realizar actividades educativas con enfermeras de la Atención Primaria de Salud sobre el plan de parto e identificar su impacto; informar y resaltar con las enfermeras de la Atención Primaria de Salud la importancia y el abordaje del plan de parto durante la atención prenatal. Metodo: Se trata de un estudio descriptivo, exploratorio, con enfoque mixto. El Municipio de Catanduva tiene cerca de 121.862 habitantes y 23 Unidades de Salud de Atención Básica, con 46 enfermeras actuando directamente en el prenatal y en actividades educativas con gestantes. Resultados: Existe discrepancia en cuanto al conocimiento y aplicación del instrumento referente al plan de parto por parte de los enfermeros de la Atención Primaria de Salud, destacando la importancia de la creación de capacitaciones y protocolos en esta temática. Conclusión: Con el desarrollo del estudio se pudo concluir cuán importante es el Plan de Parto, tanto para la gestante en el contexto de expresar sus deseos, deseos, resolver sus dudas y temores, como también es fundamental para el profesional insertado en la asistencia, ya que es un documento escrito de carácter legal, lo que lo convierte en un medio de apoyo para posibles contratiempos.(AU)