TGR5 receptor activation attenuates diabetic retinopathy through suppression of RhoA/ROCK signaling.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. Abnormal energy metabolism in microvascular endothelium is involved in the progression of diabetic retinopathy. Bile Acid G-Protein-Coupled Membrane Receptor (TGR5) has emerged as a novel regulator of metabolic disorders. However, the role of TGR5 in diabetes mellitus-induced microvascular dysfunction in retinas is largely unknown. Herein, enzyme-linked immunosorbent assay was used for analyzing bile acid (BA) profiles in diabetic rat retinas and retinal microvascular endothelial cells (RMECs) cultured in high glucose medium. The effects of TGR5 agonist on streptozotocin (STZ)-induced diabetic retinopathy were evaluated by HE staining, TUNEL staining, retinal trypsin digestion, and vascular permeability assay. A pharmacological inhibitor of RhoA was used to study the role of TGR5 on the regulation of Rho/Rho-associated coiled-coil containing protein kinase (ROCK) and western blot, immunofluorescence and siRNA silencing were performed to study the related signaling pathways. Here we show that bile acids were downregulated during DR progression in the diabetic rat retinas and RMECs cultured in high glucose medium. The TGR5 agonist obviously ameliorated diabetes-induced retinal microvascular dysfunction in vivo, and inhibited the effect of TNF-α on endothelial cell proliferation, migration, and permeability in vitro. In contrast, knockdown of TGR5 by siRNA aggravated TNF-α-induced actin polymerization and endothelial permeability. Mechanistically, the effects of TGR5 on the improvement of endothelial function was due to its regulatory role on the ROCK signaling pathway. An inhibitor of RhoA significantly reversed the loss of tight junction protein under TNF-α stimulation. Taken together, our findings suggest that insufficient BA signaling plays an important pathogenic role in the development of DR. Upregulation or activation of TGR5 may inhibit RhoA/ROCK-dependent actin remodeling and represent an important therapeutic intervention for DR.

Fio de sutura elástico / Elastic suture thread

Introdução: O tratamento de grandes e médias feridas é um desafio para os cirurgiões quando precisam fechálas e, normalmente, são utilizadas técnicas cirúrgicas de enxertias ou retalhos, que podem deixar sequelas e até mesmo mutilações. Ao longo do tempo desenvolveu-se a técnica de "sutura elástica" que promove a cicatrização em curto espaço de tempo com sequelas menores, entretanto o procedimento tem sido realizado com material improvisado. Objetivo: Desenvolver um fio de sutura elástico cirúrgico que possa ser esterilizado e confeccionado nos moldes dos produtos médicos cirúrgicos. Métodos: Revisão das patentes existentes por meio da busca de anterioridade e comparação com o dispositivo do estudo. Pesquisa de materiais com as características necessárias como elasticidade e tensão. Teste destas características em laboratórios especializados. Resultados: O produto desenvolvido é um fio elástico com duplo agulhamento para suturas, com matéria prima de silicone que apresenta elasticidade e resistência a tensão. Conclusão: O fio de sutura elástico, com duplo agulhamento, para feridas de médio e grande porte foi desenvolvido.

Introduction: Closing large and medium wounds is challenging for surgeons and often leads to the use of graft or flap surgical techniques. These procedures can leave sequelae and even mutilations. An "elastic suture" technique was developed to promote wound healing in a short time span with minor sequelae; however, improvised materials have been used in this procedure. Objective: To develop a surgical elastic suture thread that can be manufactured and sterilized following the standards of surgical medical products. Methods: We conducted a patent search, compared the findings with the study device, and researched materials with necessary characteristics such as elasticity and tension. Testing these characteristics in specialized laboratories. Results: The developed device is a double-needled elastic suture made of silicone that presents tensile strength. Conclusion: Here, we developed a double-needled elastic suture for medium and large wounds.

Aspectos sociales de la aplicación del Heberprot-P en el servicio de Angiología del Hospital Manuel Ascunce Doménech / Social aspects of the application of the Heberprot-P in the Angiology service at Manuel Ascunce Domenech Hospital

En la actualidad Cuba desarrolla un Programa de Atención Integral al Paciente con Úlcera de Pie Diabético (UPD) mediante el uso del Heberprot-P, esencial para disminuir la amputación y la discapacidad. El trabajo tiene el objetivo de realizar un diagnóstico sobre la aplicación del Heberprot-P en el Servicio de Angiología del Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey. Se realizaron encuestas a pacientes para identificar necesidades sentidas relacionadas con el tratamiento y para las actitudes manifiestas, y se hicieron entrevistas al personal médico y de enfermería. El diagnóstico permitió corroborar la necesaria investigación con enfoque social del servicio de salud escogido a nivel territorial. Destaca elevar el trabajo de captación de pacientes desde el nivel primario de salud para garantizar un mayor alcance del programa, así como la trascendencia del apoyo familiar y la relación profesional de la salud- paciente a fin de lograr la calidad requerida (AU)

At present Cuba is developing a program concerning the care of patient with ulcer of the diabetes foot by means of Heberprot-P essential to reduce the amputation and disability. The aim of this paper is to carry out a diagnosis about social aspects of the application of the Heberprot-P in the Angiology service at Manuel Ascunce Domenech Hospital in Camaguey. Some surveys were carry out to identify certain needs related with the treatment and the attitude shown and on the other hand some interview were made to the medical and nursing staff. The diagnosis allowed to verify the need of the research with social approach. The paper highlight how to incorporate patients from the primary health level, in order this program has a higher scope and the importance of the family support and the professional relationship to accomplish the quality required (AU)

Health economic benefits of cyanoacrylate skin protectants in the management of superficial skin lesions.

Superficial skin damages, including stage II pressure ulcer, skin tears and moisture-associated skin damages (MASDs) are common and constitute a significant disease burden to the health care system. A cost analysis was conducted by comparing a cyanoacrylate barrier film with routine care in the treatment of superficial skin damages in a chronic care facility. The analysis included 12 patients: four patients with stage II pressure ulcers, six with MASD and two with skin tears. Cost analysis was conducted comparing the cost of care 7 days before and 7 days after the acrylate barrier was used. The total cost took into consideration the time, products and supplies required to manage the skin problem.

Education and autonomy of nurses in the prevention and treatment of wounds / O ensino e a autonomia do enfermeiro na prevenção e no tratamento de feridas / La educación y la autonomía de enfermeros en la prevención y tratamiento de las heridas

Objetivos: Identificar os tópicos trabalhados pelos professores de enfermagem sobre prevenção e tratamento de feridas e analisá-los sob a perspectiva ética e de autonomia profissional. Método: pesquisa descritiva qualitativa. Aprovado no Comitê de ética em pesquisa sob nº 138/09. Instrumentos utilizados: entrevista semi-estruturada e observação participante. Sujeitos: cinco docentes que lecionam o conteúdo relacionado à prevenção e tratamento de feridas. Cenários: Escola de Enfermagem da Universidade Federal Fluminense e da Universidade Federal do Rio de Janeiro. Resultados: A maioria dos professores, afirmam não abordar de forma direta as questões relacionadas à autonomia do enfermeiro em relação ao tema no curso de graduação. Demonstram que durante sua formação esta questão também não foi ministrada claramente e que este fato influencia na forma que lecionam. Conclusão: Evidenciou-se a importância de implementar a integralização de competências no ensino de graduação, para que os acadêmicos adquiram sua autonomia e possam desenvolvê-la.

Objectives: To identify the topics worked by nursing teachers on the prevention and treatment of wounds and analyze them from the perspective of ethics and professional autonomy. Method: This descriptive and qualitative research approved by the Committee for Ethics in Research under No. 138/09. Instruments used: semi - structured interviews and participant observation. Subjects: five teachers who teach content related to the prevention and treatment of wounds. Scenarios: School of Nursing, Fluminense Federal University and the Federal University of Rio de Janeiro. Results: Most teachers say they do not directly address issues related to autonomy of nurses in relation to the subject at the undergraduate level. Demonstrate that during his training this issue was not clearly given and this fact influences the way they teach. Conclusion: The analysis reveals the importance of implementing the payment of skills in undergraduate education, so that students can acquire their autonomy and develop it.

Objetivos: Identificar los temas de trabajo de los profesores de enfermería en la prevención y el tratamiento de las heridas y analizarlos desde la perspectiva de la ética y la autonomía profesional. Método: investigación descriptiva y cualitativa. Aprobada por el Comité de Ética en Investigación con el Nº 138/09. Instrumentos utilizados: entrevistas semi - estructuradas y observación participante. Sujetos: cinco profesores que enseñan contenidos relacionados con la prevención y el tratamiento de las heridas. Escenarios: Escuela de Enfermería de la Universidad Federal Fluminense y la Universidad Federal de Río de Janeiro. Resultados: La mayoría de los profesores dicen que no abordan directamente los problemas relacionados con la autonomía de las enfermeras en relación con el tema a nivel de pregrado. Demostrar que durante su entrenamiento este tema no se le dio claridad y este hecho influye en la forma de enseñar. Conclusión: El análisis pone de manifiesto la importancia de aplicar el pago de las competencias en la educación universitaria, para que los estudiantes puedan adquirir su autonomía y su desarrollo.

Cultural considerations in advanced wound care.

There are many advanced wound care products composed of elements that may conflict with our patients' religious ideology or ethical mores. This article discusses religious and cultural considerations that clinicians should be aware of when selecting advanced wound care products.

O enfermeiro e o tratamento de feridas: em busca da autonomiado cuidado / Nurses and wound treatment: searching for care autonomy

O cuidado com feridas é uma atividade do cotidiano do enfermeiro. Entretanto, esse cuidado esbarra naquestão da autonomia desse profissional em suas atividades junto aos pacientes portadores de feridas. Opropósito deste estudo é avaliar a Legislação de Enfermagem brasileira sobre a autonomia do Enfermeiro nocuidado de feridas na perspectiva da prevenção e tratamento. Trata-se de uma pesquisa descritiva exploratóriacujas fontes de pesquisas foram os sites dos Conselhos Regionais de Enfermagem (CORENs) da Federaçãobrasileira e o site do Conselho Federal de Enfermagem (COFEN), bem como textos que versem sobre oassunto. Constata-se escassez de legislação acerca da autonomia do enfermeiro no tratamento de feridas;uma vez que apenas 11 documentos foram compilados os quais estão distribuídos entre seis CORENs.

Wound care is a daily activity for the nurses. However, this care is limited to these professionals when theissue is their autonomy mainly in relation to activities with the patients with wounds. The purpose of thisstudy is to evaluate the Legislation of Brazilian Nursing on the Nurse’s autonomy in the wound care accordingto prevention and treatment. It is an exploratory descriptive research whose sources were the sites ofRegional Council of Nursing (CORENs) of the Brazilian Federation and the site of Federal Council of Nursing(COFEN) as well as texts dealing with this subject. Legislation shortage was observed concerning thenurse’s autonomy in the wound treatment; once only 11 documents were compiled which are distributedamong six CORENs.

Medical authority and nursing integrity.

This paper explores the respective legitimacy or illegitimacy of medical authority over nursing work. The analysis makes use of Joseph Raz's ideas concerning the nature of authority. Various scenarios are considered which lend themselves to differing interpretations, and the conclusion reached is that acting in accordance with legitimate medical authority enhances rather than compromises the nurse's professional integrity. Difficulties, however, may lie in disentangling legitimate from illegitimate attempts to control nursing work.