Inhibition of Dorsal Root Ganglia Transient Receptor Potential Ankyrin 1 Upregulation Contributes to the Protective Effect of Morphine Against Gastric Mucosal Damage Induced by Water-Immersion Restraint Stress.

The pathogenesis mechanism of acute gastric mucosal lesions (AGML) is still unclear; further exploration is urgently needed to find a new therapeutic target. This study aimed to investigate whether morphine might regulate the expression and function of transient receptor potential ankyrin 1 (TRPA1) through a cyclic adenosine monophosphate/protein kinase A (cAMP/PKA)-dependent pathway, thereby alleviating gastric mucosal lesions caused by water-immersion restraint stress (WIRS). Rats were administered with intrathecal morphine, TRPA1 antagonist (HC-030031), µ-opioid receptor antagonist, or protein kinase A inhibitor (H-89), respectively, before WIRS. After 6 hours of WIRS, microscopic lesions, hematoxylin and eosin staining, and transmission electron microscopy were applied to assess the damage of the gastric mucosa. Real-time polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay were conducted to detect the levels of TRPA1 and substance P (SP) in the dorsal root ganglia (DRG) and gastric tissues. In addition, immunofluorescence was used to explore the possible co-expression of TRPA1 and µ-opioid receptors in the DRG. The results indicated that WIRS upregulated TRPA1 and SP in gastric mucosa, and HC-030031 or H-89 could alleviate gastric mucosal lesions caused by WIRS (P < .0001). Morphine was found to suppress both WIRS-induced gastric mucosal lesions (P < .0001) and the upregulation of TRPA1 (P = .0086) and SP (P = .0013). Both TRPA1 and SP play important roles in the pathogenesis of WIRS-induced AGML. Exogenous gastroprotective strategies reduce elevated levels of TRPA1 via the cAMP/PKA-dependent pathway. Inhibition of TRPA1 upregulation in the DRG is critical for intrathecal morphine preconditioning-induced gastric protection.

Chronic restraint stress promotes oral squamous cell carcinoma development by inhibiting ALDH3A1 via stress response hormone.

BACKGROUND: Chronic restraint stress (CRS) has iteratively been reported to be possibly implicated in the development of numerous cancer types. However, its role in oral squamous cell carcinoma (OSCC) has not been well elucidated. Here we intended to evaluate the role and mechanism. METHODS: The effects of CRS were investigated in xenograft models of OSCC by using transcriptome sequencing, LC-MS, ELISA and RT-PCR. Moreover, the role of CRS and ALDH3A1 on OSCC cells was researched by using Trans-well, flow cytometry, western blotting, immunofluorescence, ATP activity and OCR assay. Furthermore, immunohistochemical staining was employed to observe the cell proliferation and invasion of OSCC in xenotransplantation models. RESULTS: CRS promoted the progression of OSCC in xenograft models, stimulated the secretion of norepinephrine and the expression of ADRB2, but decreased the expression of ALDH3A1. Moreover, CRS changed energy metabolism and increased mitochondrial metabolism markers. However, ALDH3A1 overexpression suppressed proliferation, EMT and mitochondrial metabolism of OSCC cells. CONCLUSION: Inhibition of ALDH3A1 expression plays a pivotal role in CRS promoting tumorigenic potential of OSCC cells, and the regulatory of ALDH3A1 on mitochondrial metabolism may be involved in this process.

Contenção mecânica nos serviços de urgência e emergência / Mechanical containment in urgency and emergency services

Objetivo: identificar evidências científicas sobre o uso da contenção mecânica em pacientes adultos e idosos nos serviços de urgências e emergências. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa da literatura, realizado nas bases de dados: MEDLINE (via PubMed), CINAHL, SCOPUS e LILACS, nos últimos cinco anos, 2014 a 2019. Avaliaram-se e classificaram-se os estudos quanto ao seu rigor científico, para a classificação do Nível de Evidência, por meio de um instrumento baseado na Rating System for the Hierachy of Evidence for Intervention/Treatment Question. Resultados: encontraram-se três estudos, no Havaí, Canadá e Austrália, produzidos em 2014 e 2016, sendo dois artigos com abordagem quantitativa e um artigo qualitativo, todos na língua inglesa. Informa-se que dois tratavam de implementação de estratégias de educação para reduzir o uso da contenção e um sobre a percepção dos profissionais de saúde sobre o uso da contenção. Conclusão: conclui-se que estratégias educacionais para profissionais de saúde são necessárias para reduzir o uso da contenção mecânica, evitando resultados deletérios não só para os pacientes, mas para a equipe.

Objective: to identify scientific evidence on the use of mechanical restraint in adult and elderly patients in urgent and emergency services. Method: this is a bibliographic, descriptive, integrative review of the literature, carried out in the databases: MEDLINE (via PubMed), CINAHL, SCOPUS and LILACS, in the last five years, 2014 to 2019. They were evaluated and classified the studies are based on their scientific rigor, for the classification of the Level of Evidence, using an instrument based on the Rating System for the Hierachy of Evidence for Intervention / Treatment Question. Results: three studies were found, in Hawaii, Canada and Australia, produced in 2014 and 2016, two articles with a quantitative approach and one qualitative article, all in English. It is reported that two dealt with the implementation of education strategies to reduce the use of restraint and one about the perception of health professionals about the use of restraint. Conclusion: it is concluded that educational strategies for health professionals are necessary to reduce the use of mechanical restraint, avoiding deleterious results not only for patients, but for the team.

Objetivo: identificar evidencia científica sobre el uso de restricciones mecánicas en pacientes adultos y ancianos en servicios urgentes y de emergencia. Método: esta es una revisión bibliográfica, descriptiva, integradora de la literatura, realizada en las bases de datos: MEDLINE (a través de PubMed), CINAHL, SCOPUS y LILACS, en los últimos cinco años, 2014 a 2019. Fueron evaluados y clasificados los estudios en cuanto su rigor científico, para la clasificación del Nivel de Evidencia, utilizando un instrumento basado en el Rating System for the Hierachy of Evidence for Intervention/Treatment Question. Resultados: se encontraron tres estudios, en Hawai, Canadá y Australia, producidos en 2014 y 2016, dos artículos con un enfoque cuantitativo y un artículo cualitativo, todos en inglés. Se informa que dos se ocuparon de la implementación de estrategias educativas para reducir el uso de la contención y uno sobre la percepción de los profesionales de la salud sobre el uso de la contención. Conclusión: se concluye que las estrategias educativas para los profesionales de la salud son necesarias para reducir el uso de contención mecánica, evitando resultados nocivos no solo para los pacientes, sino también para el equipo.

The experience of people with mental disorders in social function adaptation after suffering from pasung

Objective: Pasung is a physical restraint or confinement of people with mental disorders performed by non-professional members of society. It can cause various effects on people with mental disorders. Pasung can affect the people adaptation to functioning socially in society following the release from pasung. The purpose of this study was to describe the experience of people with mental disorders, post-pasung, in adapting to society Method: This was a qualitative study, using a descriptive phenomenological approach. Purposive sampling was used to select the participants. Data were obtained though in-depth interviews with seven participants, and the data were analyzed by using Colaizzi's method. Results: Pasung has a physical and psychosocial impact on people with mental disorders in adapting to society. The results of the study can be summarized by four themes: a) withdrawal from others as an initial manifestation of release from pasung; b) biopsychosocial changes after pasung that act as an impediment to performing a social function; c) improved social function through the optimization of support systems, and d) satisfaction with life as a result of social adaptation. Conclusions: Increased social support is needed to optimize the social function of people with mental disorders, post-pasung

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The experience of restraint-use among patients with violent behaviors in mental health hospital

Objective: Patients with violent behavior can harm themselves, others and environment. It can be an indicator for mental health hospital admission. Violent behaviors can be characterized by verbal and physical attacks demonstrated by the individuals intensively. Management of violent behaviors in hospital often uses restraint, but it has physical and psychological effects. This study aimed to explore experience of restraint use among patients with violent behaviors in mental health hospital. Method: To gain deep understanding related to the patients' experiences, this study used a qualitative design with a phenomenological approach. Purposive sampling was employed to find patients who were restrained during their hospitalization. The number of participants in this study was 8 participants. The data were analyzed with Colaizzi's method. Results: Patients with violent behavior, specifically with physical restraint during their hospital-ization had negative impacts on patients. The results of this study were described in three themes: 1) aggressive behavior as one of the main reason of restraint; 2) professional healthcare supports during the restraint use, and 3) physical and psychosocial impact of the restraint use. Conclusions: The impact of restraint is related to human right violations and ethical dilemma. The process of decision-making for employing restraint, especially in relation to violent behavior management, requires a consideration of the rights of the patient. Every individual has the right of self-determination, liberty, security and physical integrity

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Development of the nursing diagnosis risk for pressure ulcer / Desarrollo del diagnóstico de enfermería riesgo de úlcera por presión / Desenvolvimento do diagnóstico de enfermagem risco de úlcera por pressão

OBJECTIVE: The study objective was to develop the definition and compile the risk factors for a new Nursing Diagnosis entitled "Risk for pressure ulcer". The process was guided using the research question, "What are the risk factors for development of a PU and what is its definition?" METHOD: An integrative literature review was conducted of articles published in Portuguese, English or Spanish from 2002 to 2012 and indexed on the Lilacs/SCIELO, MEDLINE/PubMed Central and Web of Science databases. The final sample comprised 21 articles that provided answers to the research question. These articles were analyzed and summarized in charts. RESULTS: A definition was constructed and 19 risk factors were selected for the new nursing diagnosis, "Risk for pressure ulcer". CONCLUSIONS: Identification and definition of the components of the new nursing diagnosis should aid nurses to prevent pressure ulcer events. .

OBJETIVO: El desarrollo de la definición y de los factores de riesgo de un nuevo diagnóstico de enfermería denominado Riesgo de úlcera por presión. La pregunta guía fue: "¿Qué es úlcera por presión y cuáles son los factores de riesgo? MÉTODO: Revisión integradora de la literatura con artículos en portugués, inglés y español publicados entre 2002 y 2012 en las bases de datos electrónicos Lilacs/SCIELO, MEDLINE/PubMed Central y Web of Science. La muestra fue compuesta por 21 artículos que respondieron a la pregunta guía de la encuesta los cuales fueron analizados mediante cuadros sinópticos. RESULTADOS: Se desarrolló la definición y se enumeraron 19 factores de riesgo para el nuevo diagnóstico de enfermería de Riesgo de úlcera por presión. CONCLUSIÓN: La encuesta permitió identificar y definir los componentes de ese nuevo diagnóstico de enfermería que auxiliará al enfermero en la prevención de la úlcera por presión. .

OBJETIVO: Estudo com objetivo de desenvolver a definição e os fatores de risco de um novo diagnóstico de enfermagem denominado risco de úlcera por pressão. Para tanto, utilizou-se a questão norteadora: "o que é úlcera por pressão e quais os seus fatores de risco?" MÉTODO: Revisão integrativa da literatura referente a artigos publicados em português, inglês e espanhol, no período entre 2002-2012, nas bases de dados eletrônicas Lilacs/SCIELO, MEDLINE/PubMed Central e Web of Science. A amostra foi composta por 21 artigos que responderam à questão norteadora, os quais foram analisados por meio de quadros sinópticos. RESULTADOS: Desenvolveu-se a definição e elencaram-se 19 fatores de risco para o novo diagnóstico de enfermagem denominado Risco de úlcera por pressão. CONCLUSÃO: A identificação e a definição desses componentes do novo diagnóstico de enfermagem poderão auxiliar o enfermeiro na prevenção do evento úlcera por pressão. .

Actuación medicolegal en personas en custodia judicial o policial / Medical-legal conduct with individuals in judicial or police custody

La problemática asistencial de personas en custodia así como la muerte en custodia son aspectos relevantes para la medicina legal y forense, en relación con la posibilidad de responsabilidad penal, civil y administrativa de los profesionales sanitarios y/o instituciones públicas o privadas que puedan tener en custodia sujetos privados de libertad. Un estado de derecho debe garantizar que en estos casos se cumplan la legislación estatal y los tratados y compromisos internacionales relacionados con los derechos humanos, y el tratamiento especial de personas privadas de libertad en centros hospitalarios o de detención. Mención particular merece la actuación médico forense en las muertes en situaciones de reducción y/o contención en el momento de la detención de un sujeto por miembros de las fuerzas y cuerpos de seguridad, o en centros asistenciales por personal de seguridad o asistencial. En estos casos, tanto el tratamiento asistencial inmediato posterior a los hechos como el estudio médico forense deberán ser particularmente cuidadosos. Estas situaciones, habitualmente mediáticas, provocan alarma social y conllevan actuaciones judiciales que puede derivar en responsabilidades especialmente graves (AU)

The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities (AU)

Aspectos medicolegales de la contención física y farmacológica / Medical-legal issues of physical and pharmacological restraint

El uso de la contención física y farmacológica resulta controvertido, pero se acepta hoy en día como inevitable, encontrándose indicado en el control de las alteraciones de conducta y la agitación psicomotriz con riesgo para el paciente o para terceros. Su indicación ha de ser médica y optar por la medida que resulte menos restrictiva. Potencialmente, las contenciones suponen una vulneración de derechos fundamentales del paciente y precisan el conocimiento y respeto estricto de los preceptos medicolegales por parte de los facultativos y demás profesionales implicados en su aplicación. El presente artículo revisa el marco legal actual, así como las premisas y aspectos medicolegales de aplicación en las contenciones, con el objetivo de garantizar el máximo respeto a los derechos de los pacientes y la adecuada seguridad jurídica en la actuación de los profesionales (AU)

The use of physical and pharmacological restraint is controversial but is currently accepted as inevitable. It is indicated for controlling behavioral disorders and psychomotor agitation that put patients and third parties at risk. Its indication should be medical, and we should opt for the least restrictive measure. Restraints represent a possible infringement of patients’ fundamental rights and require understanding and strict respect for the medical-legal precepts by physicians and other practitioners involved in its application. This article reviews the current legal framework, as well as the medical-legal premises and aspects of applying restraints, with the objective of ensuring maximum respect for patients’ rights and the appropriate legal safety in the activity of practitioners (AU)

Accidentes asociados al uso de restricciones físicas en ancianos con trastornos cognitivos: estudio de tres casos / Accidents associated with the use of physical restraints in the elderly with cognitive disorders: a study of three cases

IntroducciónLa restricción física suele aplicarse en ancianos con trastornos cognitivos bajo la convicción de que mejora su seguridad. Sin embargo, diversos estudios advierten del riesgo de que se produzca un percance grave cuando estas personas quedan atrapadas por el dispositivo al tratar de salir de la cama o del sillón. Se estima que sólo en EE. UU. se producen unas 200 muertes al año como resultado de un accidente causado por estos mecanismos.Material y métodosSe estudiaron las circunstancias en las que se produjo la muerte de 3 ancianos con trastornos cognitivos a los que se les estaba aplicando un cinturón de sujeción abdominal en el momento de su fallecimiento. Los datos fueron recopilados de las historias clínicas y a través de una entrevista semiestructurada con los profesionales responsables de los pacientes.ResultadosEntre los factores que pudieron facilitar los sucesos estarían la desorientación y la incapacidad de los pacientes para reconocer riesgos, la escasa vigilancia sobre éstos, la aplicación incorrecta de los dispositivos, una baja ratio de personal en determinados turnos y una insuficiente formación.ConclusionesSe observa que tanto los casos analizados como los descritos en la bibliografía presentan patrones comunes y que una probable combinación de factores sea lo que incremente la posibilidad de que ocurra un accidente(AU)

IntroductionPhysical restraint is normally applied to the elderly with cognitive disorders in the belief that it improves their safety. However, several studies warn about the risk of a serious accident when these people become trapped by the equipment when trying to get up from a bed or chair. It is estimated that in the USA alone, as many as 200 deaths are caused annually by these devices.Material and methodsThe circumstances resulting in the deaths of three elderly people with cognitive impairment and an abdominal belt restraint at the time of death were studied. The information was collected from clinical histories and through a semi-structured interview with the professionals in charge of the patients.ResultsAmong the possible contributing factors to these incidents could be the patients’ disorientation and inability to recognize risks, the lack of adequate supervision, incorrect application of the devices, a low staff ratio on some shifts and insufficient staff training.ConclusionsBoth the literature review and the cases analyzed show a common pattern. A probable combination of factors could increase the possibility of an accident occurring(AU)

Ascorbic acid protects against restraint stress-induced memory deficits in wistar rats

OBJECTIVE: Chronic stress has been shown to cause oxidative damage in the central nervous system. Although stress-induced impairments in learning and memory have been studied extensively, very few studies have investigated possible ways to prevent their ill effects. The present work was designed to study the protective effects of ascorbic acid in memory loss induced by chronic restraint stress. METHODS: Adult male Wistar rats were designated into the following groups: (i) Normal control, (ii) Ascorbic acid treatment, (iii) Vehicle control, (iv) Restraint stress, (v) Restraint stress + vehicle, and (vi) Restraint stress + ascorbic acid treatment. At the end of 21 days, animals of all groups were subjected to memory tests using Morris water maze and passive avoidance apparatus. Then, the results obtained were compared between the experimental groups. RESULTS: Rats exposed to restraint stress alone and those pretreated with vehicle solution before restrained stress showed deficits in learning and impaired memory retention in the memory tests when compared to animals in other experimental groups. Animals pretreated with ascorbic acid before restraining showed significant improvement in memory retention in the same memory tests. CONCLUSIONS: Results of this study suggest the possibility of using ascorbic acid as a dietary supplement to prevent stress-induced memory impairments.

Recent progress in research on positional asphyxia of restraint / 法医学杂志

Positional asphyxia of restraint means that when an individual was limited in an abnormal body position, asphyxia would take place owing to the disorder of spontaneous respiratory function, and finally it lead to die. So, it belongs to a special type of the mechanical asphyxia. From the cases reported, we could found that it would take place in several conditions. Because the cases were not caused enough recognition, the study has been researched carefully only in recent years. Following the more cases reported, many experts of forensic medicine had investigated it on the mechanism of death and the standard of identification, but they could not reach to agreements. So, they have changed the directions of the researches, began to value the factors of risk and research how to avoid it. In the following text, the mechanism of death, factors of risk, preventive methods, standard of identification and prospecting of positional asphyxia of restraint were reviewed.

Las úlceras de decúbito

Las úlceras de decúbito o presión se producen por la compresión sostenida en una determinada zona corporal. Esto implica una disminución local de la circulación sanguínea y la consecuente isquemia de los tejidos que conducen a la necrosis. Existen otros factores de riesgo asociados que contribuyen a favorecer la aparición de estas lesiones, como la inmovilidad, la humedad, las deficiencias asistenciales, las deficiencias nutricionales y la propia patología inherente al individuo.Un adecuado manejo del paciente inmovilizado y una buena actitud ante la aparición de los primeros signos premonitorios pueden disminuir tanto la incidencia como la gravedad de estas lesiones. No obstante, la aparición de úlceras de decúbito no es un buen marcador de calidad, en cuanto a asistencia de los profesionales sanitarios, si no se tiene en cuenta las características de estos pacientes, su estado general y otros factores asociados.En este artículo, pretendemos hacer un recordatorio respecto a este problema, que tantas veces se olvida en la praxis sanitaria (AU)

Efeito da inatividade física sobre parâmetros bioquímicos e grau de ateromatose aórtica em coelhos / Effect of lack of physical activity of rabbits in biochemical data and aortic atheromatosis

Foi realizada uma experiência durante 80 dias, usando 32 coelhas em fase de crescimento. Os animais foram distribuídos em quatro grupos (A, B, C e D) de oito animais cada. Os animais dos grupos A e C permaneceram soltos, sendo que os do grupo A foram alimentados com raçäo basal e os do grupo C com raçäo aterogênica (raçäo basal + 0,5% de colesterol). Os animais dos grupos B e D permaneceram praticamente imobilizados em gaiolas estreitas e foram alimentados, respectivamente, com raçäo basal e raçäo aterogênica. Os resultados obtidos permitem inferir que a inatividade física tem efeito nocivo no processo ateromatoso. De fato, foram observados aumentos (relacionados à quantidade de colesterol ingerido), maiores nos animais engaiolados em relaçäo aos soltos, de lipídios totais no plasma sangüineo e no fígado (significativo); e de colesterol total no fígado, na aorta e no músculo (significativo). Além disso, o grau de ateromatose aórtica foi significativamente mais severo nos animais engaiolados

Efeitos decorrentes da restriçäo mecânica no doente / Adverse effects of mechanical restriction in patients

Neste estudo, versando sobre a restriçäo mecânica tecnologia utilizadas pela enfermagem na limitaçäo dos movimentos normais do doente hospitalizado e acamado, procurou-se investigar as alteraçöes físicas e emocionais decorrente do emprego desse procedimento em doentes internados nos hospitais gerais governamentais de Salvador. Trata-se de um trabalho descritivo, realizado em unidades de internacäo de cuidados intermediários (médicas e cirúrgicas), usando na populaçäo de 90 doentes de ambos os sexos. Para a obtençäo dos dados utilizou-se formulário aplicado na observaçäo do doente. Os resultados obtidos, quando submetidos ao teste Chi-Quadrado, demonstraram relaçäo com as variáveis do estudo (alteraçöes físicas, alteraçöes emocionais, características do doente, elementos da restriçäo, registro da restriçäo e medidas preventivas) e evidenciaram a ocorrência de efeitos físicos e emocionais nocivos ao doente, decorrentes do uso da referida tecnologia, a despeito de sua ampla aceitaçäo e utilizaçäo pela equipe de enfermagem. Sugere-se, em consequência, o emprego de uma assistência de enfermagem individualizada e qualificada de maneira a evitar o uso indiscriminado dessa tecnologia