Evaluation of the perception of clinical competencies by nursing students in the different clinical settings: an observational study.

INTRODUCTION: The university educational sphere has many dilemmas. The question of sufficient knowledge and skills for students to acquire abilities to provide care in different clinical setting is one important dilemma. AIM: To measure the level of competencies by nursing students and its application in different clinical environments. METHODS: Nursing students of two Italian universities participated in the research. Data collection took place April to July 2015 using the Nurse Competence Scale. The Strengthening Reporting of Observational Studies in Epidemiology Guidelines was used to describe the study. Pearson's chi-square test, Student's t test, and regression tests were used for statistical analysis. RESULTS: The questionnaire response rate was 87.27% (n = 698). Most of the nursing students assessed their level of competency as 'good' and evaluated themselves as more competent than their actual nursing role. Students also appraised themselves as competent either via their clinical practices accomplished or in the therapeutic interventions. CONCLUSION: This study shows that the self-evaluation of the competencies acquired by nursing students in clinical settings in Latium and Abruzzo is of a good standard. This study also affirms that NCS is a valuable and reliable tool to measure clinical competencies in different clinical settings.

Hotspots of microplastic accumulation at the land-sea transition and their spatial heterogeneity: The Po River prodelta (Adriatic Sea).

Deltas are the locus of river-borne sediment accumulation, however, their role in sequestering plastic pollutants is still overlooked. By combining geomorphological, sedimentological, and geochemical analyses, which include time-lapse multibeam bathymetry, sediment provenance, and µFT-IR analyses, we investigate the fate of plastic particles after a river flood event providing an unprecedented documentation of the spatial distribution of sediment as well as of microplastics (MPs), including particles fibers, and phthalates (PAEs) abundances in the subaqueous delta. Overall sediments are characterized by an average of 139.7 ± 80 MPs/kg d.w., but display spatial heterogeneity of sediment and MPs accumulation: MPs are absent within the active sandy delta lobe, reflecting dilution by clastic sediment (ca. 1.3 Mm3) and sediment bypass. The highest MP concentration (625 MPs/kg d.w.) occurs in the distal reaches of the active lobe where flow energy dissipates. In addition to MPs, cellulosic fibers are relevant (of up to 3800 fibers/kg d.w.) in all the analyzed sediment samples, and dominate (94 %) with respect to synthetic polymers. Statistically significant differences in the relative concentration of fiber fragments ≤0.5 mm in size were highlighted between the active delta lobe and the migrating bedforms in the prodelta. Fibers were found to slightly follow a power law size distribution coherent with a one-dimensional fragmentation model and thus indicating the absence of a size dependent selection mechanism during burial. Multivariate statistical analysis suggests traveling distance and bottom-transport regime as the most relevant factors controlling particle distribution. Our findings suggest that subaqueous prodelta should be considered hot spots for the accumulation of MPs and associated pollutants, albeit the strong lateral heterogeneity in their abundances reflects changes in the relative influence of fluvial and marine processes.

Cellular prognostic markers in hepatitis-related hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and accounts for about 6% of all new cancers diagnosed worldwide. Moreover, it is the third and the fifth leading cause of death from cancer in men and women, respectively. HBV and HCV chronic infection is the main risk factor for HCC. A range of therapies are used in the management of HCC according to the extent and severity of liver disease. In this perspective, evaluation of prognosis represents a crucial step for proper management of HCC patients. However, the clinical outcome can be significantly different in HCC patients within the same stage of disease. Therefore, many efforts have been made to define new parameters with more precise prognostic value, and the search for HCC prognostic markers is gaining momentum. The present review aims at providing an update on cellular prognostic markers for HCC.

Randomized trial of direct coronary angioplasty versus intravenous streptokinase in acute myocardial infarction.

OBJECTIVES: The objective of this study was to obtain preliminary data on the relative clinical utility of direct coronary angioplasty compared with that of intravenous thrombolytic therapy for patients with acute myocardial infarction. BACKGROUND: The relative merits of intravenous thrombolytic therapy and direct coronary angioplasty as treatment for acute myocardial infarction are incompletely understood, and randomized trials of these treatments have been extremely limited. METHODS: One hundred patients with ST segment elevation presenting to a single high volume interventional center within 6 h of the onset of chest pain were randomized to receive either streptokinase (1.2 million U intravenously over 1 h) or immediate catheterization and direct coronary angioplasty. Patients were excluded for age > or = 75 years, prior bypass surgery, Q wave infarction in the region of ischemia or excessive risk of bleeding. All patients were then treated with aspirin (325 mg orally/day) and heparin (1,000 U intravenously/h) for 48 h until catheterization was performed to determine the primary study end point, namely, infarct-related artery patency at 48 h. Secondary end points were in-hospital death, left ventricular ejection fraction at 48 h and time to treatment. RESULTS: There was no difference in the baseline characteristics of the two treatment groups. Overall patient age was 56 +/- 10 years, 83% of patients were male, 11% had prior infarction, 40% had anterior infarction and 97% were in Killip class I or II. Although time to treatment was delayed in the angioplasty group (238 +/- 112 vs. 179 +/- 98 min, p = 0.005), there was no difference in 48-h infarct-related artery patency or left ventricular ejection fraction (patency 74% vs. 80%; ejection fraction 59 +/- 13% vs. 57 +/- 13%; angioplasty vs. streptokinase, p = NS for both). There were no major bleeding events, and the mortality rate with angioplasty (6%) and streptokinase (2%) did not differ (p = NS). CONCLUSIONS: These results suggest that intravenous thrombolytic therapy might be preferred over coronary angioplasty for most patients because of the often shorter time to treatment.

Functional characterization of biodegradable nanoparticles as antigen delivery system.

BACKGROUND: Peptide based vaccines may suffer from limited stability and inefficient delivery to professional antigen-presenting cells (APCs), such as dendritic cells (DCs). In order to overcome such limitations, several types of biodegradable nanoparticles (NPs) have been developed as carrier system for antigens. The present study describes for the first time the extensive biological characterization of cationic NPs made of poly (D,L-lactide-co-glycolide) (PLGA) and polyethylenimine (PLGA/PEI) as delivery system for protein/peptide antigens, with potential in therapeutic cancer vaccine development. RESULTS: Flow cytometry as well as confocal laser scanning microscopy (CLSM) showed that PLGA/PEI NPs are more readily taken up than PLGA NPs by both human CD14(+) monocytes and mouse Hepa 1-6 hepatoma cell line. No signs of toxicity were observed in either cellular setting. Sequential image acquisition by TEM showed an intracellular apical localization for PLGA NPs and a perinuclear localization for PLGA/PEI NPs. Both NPs showed a clathrin-dependent as well as a caveolin-dependent internalization pathway and, once in the cells, they formed multivesicular endosomes (MVE). Finally, an ex vivo priming experiment showed that PLGA/PEI NPs are comparable to PLGA NPs in delivering a non-self antigen (i.e., ovalbumin - OVA) to immature dendritic cells (imDCs), which matured and induced autologous naïve CD4(+) T cells to differentiate to memory (i.e., central memory and effector memory) cells. Such a differentiation was associated with a Th1 phenotype suggesting a downstream activation and amplification of a CD8(+) T cell cytotoxic response. The same OVA antigen in a soluble form was unable to induce maturation of DCs, indicating that both NP formulations provided an intrinsic adjuvanting effect combined to efficient antigen delivery. CONCLUSIONS: Our study represents the first report on side-by-side comparison of PLGA and PLGA/PEI NPs as strategy for protein antigen delivery. PLGA/PEI NPs are superior for cellular uptake and antigen delivery as compared to PLGA NPs. Such an evidence suggests their great potential value for vaccine development, including therapeutic cancer vaccines.

Loss of Drosophila pseudouridine synthase triggers apoptosis-induced proliferation and promotes cell-nonautonomous EMT.

Many developing tissues display regenerative capability that allows them to compensate cell loss and preserve tissue homeostasis. Because of their remarkable regenerative capability, Drosophila wing discs are extensively used for the study of regenerative phenomena. We thus used the developing wing to investigate the role played in tissue homeostasis by the evolutionarily conserved eukaryotic H/ACA small nucleolar ribonucleoprotein pseudouridine synthase. Here we show that localized depletion of this enzyme can act as an endogenous stimulus capable of triggering apoptosis-induced proliferation, and that context-dependent effects are elicited in different sub-populations of the silenced cells. In fact, some cells undergo apoptosis, whereas those surrounding the apoptotic foci, although identically depleted, overproliferate. This overproliferation correlates with ectopic induction of the Wg and JAK-STAT (Janus kinase-signal transducer and activator of transcription) mitogenic pathways. Expression of a p35 transgene, which blocks the complete execution of the death program and generates the so-called 'undead cells', amplifies the proliferative response. Pseudouridine synthase depletion also causes loss of apicobasal polarity, disruption of adherens cell junctions and ectopic induction of JNK (c-Jun N-terminal kinase) and Mmp1 (matrix metalloproteinase-1) activity, leading to a significant epithelial reorganization. Unexpectedly, cell-nonautonomous effects, such as epithelial mesenchymal transition in the contiguous unsilenced squamous epithelium, are also promoted. Collectively, these data point out that cell-cell communication and long-range signaling can take a relevant role in the response to pseudouridine synthase decline. Considering that all the affected pathways are highly conserved throughout evolution, it is plausible that the response to pseudouridine synthase depletion has been widely preserved. On this account, our results can add new light on the still unexplained tumor predisposition that characterizes X-linked dyskeratosis, the human disease caused by reduced pseudouridine synthase activity.

[Myocardial revascularization through small left anterior minithoracotomy]. / Revascularização do miocárdio através de minitoracotomia esquerda.

PURPOSE: To analyze the results of myocardial revascularization through small left anterior thoracotomy utilizing the left thoracic internal artery (LTIA) to left anterior descending coronary artery (LAD) without cardiopulmonary bypass, in order to simplify the operative procedure. METHODS: From September/95 till August/96 we operated on 45 patients with lesions in LAD or LAD and diagonal arteries that were revascularized with an anastomoses of the LTIA to LAD or LAD and diagonal as composite grafts, through left anterior small thoracotomy. In the second postoperative day 43 out of 45 patients were restudied with arteriography and/or transthoracic echocardiography that showed excellent patency in 39 of them. RESULTS: Six patients with obstruction or stenoses were reoperated through median sternotomy without complications. We did not observe flow through intercostal arteries in these restudies except in cases of obstructed anastomosis, showing that it is not necessary to ligate these branches. We observed too, excellent correlation between angiographic patterns and diastolic flows detected in the thoracic internal artery with transthoracic echocardiography. CONCLUSION: These initial results suggest that this approach may be good to a subset of patients with lesions in LAD and/or diagonal arteries and if associated with complementary angioplasties of other coronary arteries may be the best choice of invasive treatment of coronary insufficiency in a near future.

[Thrombolysis with intravenous APSAC in patients with acute myocardial infarction]. / Trombólise com apsac endovenoso em pacientes com infarto agudo do miocárdio.

PURPOSE: Analysis of the first 20 patients with acute myocardial infarction (AMI) who were treated with intravenous APSAC. METHODS: Twenty patients with AMI less than 6 hours of duration of symptoms were treated with IV APSAC bolus of 30 mg. Seventeen were males, ages ranging between 40 and 73 (mean 54) years. The first angiographic study was performed in 90 minutes and 5-7 days after drug administration. RESULTS: In the angiographic study performed at 90 minutes the infarct--related artery were left anterior descending (LAD) in 7 patients (35%), right coronary artery (RCA) in 9 (45%) and left circumflex (LCX) in 4 (20%). In 14 (70%) of the patients had patent infarct-related artery and the mean of left ventricular ejection fraction (LVEF) was 0.49 +/- 0.15. In six non recanalized patients the mean LVEF was 0.40 +/- 0.14. No complications were observed, and in the second angiographic study one patient showed reocclusion of the infarct-related artery. CONCLUSION: Because of easy application (IV bolus), no complication and high rate of early recanalization, IV APSAC seems to be an efficient thrombolytic agent in the treatment of patients with AMI.

[Assessment of left internal thoracic artery anastomosis with left anterior descending coronary artery by Doppler echocardiography]. / Avaliação da anastomose de artéria torácica interna esquerda com artéria interventricular anterior pela ecodopplercardiografia.

PURPOSE: To study the value of Doppler echocardiography as a tool for the evaluation of left internal thoracic artery graft (LITAG) patency in patients who underwent coronary revascularization using minimally invasive bypass surgery without extracorporeal circulation. METHODS: The first 12 consecutive patients were studied after coronary artery bypass surgery using a 5 MHz Doppler transducer. Doppler signals for the systolic and diastolic flow velocities were preferably obtained in the second intercostal space. All patients underwent coronary angiography while hospitalized. RESULTS: The exam was feasible in 93% of patients. Doppler flow pattern was predominantly diastolic (pattern A) in patients with patent anastomoses (6/7). In patients with occluded anastomoses (4/4) Doppler flow pattern was predominantly systolic (pattern B) (p = 0.003). CONCLUSION: Internal thoracic artery flow pattern as measured by Doppler echocardiography after minimally invasive coronary artery bypass graft surgery is an accurate method for identifying LITAG patency.

[Treatment of pulmonary thromboembolism with extrinsic plasminogen activator. A case report]. / Tratamento do tromboembolismo pulmonar com ativador extrínseco do plasminogênio. Relato de caso.

A 49 year-old woman with acute pulmonary thromboembolism and severe hemodynamic impairment was successfully treated with tissue-type plasminogen activator (r-TPA). She did not have previous pulmonary or cardiac diseases. Thirty days after immobilization of the right ankle, she had a sudden onset of dyspnea, epigastrial pain and syncope. As heparin therapy was unsuccessful, 90 mg of IV r-TPA was administered. There was rapid clinical and hemodynamic improvement of her condition. Pulmonary scanning one week later was normal and she was discharged without symptoms 12 days after the acute episode.

Avaliação da anastomose de artéria torácica intrna esquerda com artéria interventricular anterior pela ecodopplercardiografia / Evaluation of left internal thoracic artery anastomosis with left anterior descending coronary artery by Doppler echocardiography

OBJETIVO - Avaliar o valor do ecocardiograma Doppler (ECO) transtorácico na identificação de perviabilidade da anastomose entre artéria torácica interna esquerda (ATIE) e interventricular anterior, realizada pela técnica de revascularização miocárdica pela minitoracotomia sem circulação extracorpórea. MÉTODOS - Estudaram-se os primeiros 12 pacientes, consecutivos, no período de pós-operatório intra-hospitalar pelo ECO, utilizando-se transdutores de 5 MHz, pela via paraesternal esquerda, preferencial. Foram analisadas velocidades máximas e integrais de velocidade dos componentes sistólico e diastólico das curvas espectrais de fluxo Doppler. Todos pacientes foram submetidos à cinecoronariografia, enquanto hospitalizados. RESULTADOS - O ECO foi exeqüível em 93 'por cento' dos pacientes. Nos com anastomose pérvia (6/7), observou-se ao estudo do Doppler amplo componente diastólico (padrão A). Naqueles com anastomose obstruída (4/4) o padrão observado foi de predomínio sistólico (padrão B) (p=0,003*). CONCLUSÄO - O ECO da ATIE anastomosada com a artéria interventricular anterior, após cirurgia de revascularização miocárdica pela técncia de minitoracotomia, permitiu caracterizar precocemente, com recisão, a pervibilidade da anastomose.