Stress amongst dental students in the transition from preclinical training to clinical training: A qualitative study.

OBJECTIVES: The present study sought to qualitatively evaluate third-year undergraduate dental students' perceptions of sources of stress during the transition from preclinical to clinical training. METHODS: This was an observational, cross-sectional, and qualitative study with a nonprobabilistic sampling design. The sample consisted of students in the third year of the five-year undergraduate degree program in dentistry offered by the São Paulo State University (UNESP), School of Dentistry, Araraquara, São Paulo State, Brazil (n = 37). Data were collected using open-ended, semistructured, and individual interviews that were recorded on a digital voice recorder. The students were interviewed on campus at a previously scheduled time. Efforts were made to provide a secure and welcoming environment for the interview. The interview questions addressed students' adaptation to clinical training and their perceptions of stress resulting from this transition. Data analysis was based on the qualitative and quantitative Discourse of the Collective Subject (DCS) technique performed with the aid of Qualiquantisoft®. RESULTS: Most of the students evaluated (75.7%) reported difficulty in the transition from the preclinical to the clinical phase of their program and that this difficulty increased their stress levels during this transition (81.1%). The most frequently cited reason for the increase in stress was the responsibility and demands associated with caring for real patients (54.1%). Almost half of the students (48.6%) reported feeling physical symptoms of stress such as tachycardia, dizziness, headache, and muscle tension during this period. Most of the students (81.1%) required up to one semester to feel that they had adapted to the clinic. Many students used stress reduction strategies such as simply trying to calm down, studying before their clinical work, improving organisation, and asking professors for help. Adaptation to ergonomics and biosafety in the clinic was the most frequently cited impediment (45.9%) to the adaptation process. The students' main suggestions for reducing stress in this transition phase were additional preclinical training in a clinical setting, a more gradual transition, and greater professor receptiveness. CONCLUSION: The dental students interviewed herein perceived high levels of stress during the transition from preclinical to clinical training.

Upregulation of the novel lncRNA U731166 is associated with migration, invasion and vemurafenib resistance in melanoma.

Our previous work using a melanoma progression model composed of melanocytic cells (melanocytes, primary and metastatic melanoma samples) demonstrated various deregulated genes, including a few known lncRNAs. Further analysis was conducted to discover novel lncRNAs associated with melanoma, and candidates were prioritized for their potential association with invasiveness or other metastasis-related processes. In this sense, we found the intergenic lncRNA U73166 (ENSG00000230454) and decided to explore its effects in melanoma. For that, we silenced the lncRNA U73166 expression using shRNAs in a melanoma cell line. Next, we experimentally investigated its functions and found that migration and invasion had significantly decreased in knockdown cells, indicating an essential association of lncRNA U73166 for cancer processes. Additionally, using naïve and vemurafenib-resistant cell lines and data from a patient before and after resistance, we found that vemurafenib-resistant samples had a higher expression of lncRNA U73166. Also, we retrieved data from the literature that indicates lncRNA U73166 may act as a mediator of RNA processing and cell invasion, probably inducing a more aggressive phenotype. Therefore, our results suggest a relevant role of lncRNA U73166 in metastasis development. We also pointed herein the lncRNA U73166 as a new possible biomarker or target to help overcome clinical vemurafenib resistance.

Contributions of HOX genes to cancer hallmarks: Enrichment pathway analysis and review.

Homeobox genes function as master regulatory transcription factors during development, and their expression is often altered in cancer. The HOX gene family was initially studied intensively to understand how the expression of each gene was involved in forming axial patterns and shaping the body plan during embryogenesis. More recent investigations have discovered that HOX genes can also play an important role in cancer. The literature has shown that the expression of HOX genes may be increased or decreased in different tumors and that these alterations may differ depending on the specific HOX gene involved and the type of cancer being investigated. New studies are also emerging, showing the critical role of some members of the HOX gene family in tumor progression and variation in clinical response. However, there has been limited systematic evaluation of the various contributions of each member of the HOX gene family in the pathways that drive the common phenotypic changes (or "hallmarks") and that underlie the transformation of normal cells to cancer cells. In this review, we investigate the context of the engagement of HOX gene targets and their downstream pathways in the acquisition of competence of tumor cells to undergo malignant transformation and tumor progression. We also summarize published findings on the involvement of HOX genes in carcinogenesis and use bioinformatics methods to examine how their downstream targets and pathways are involved in each hallmark of the cancer phenotype.

Non-Syndromic Intellectual Disability and Its Pathways: A Long Noncoding RNA Perspective.

Non-syndromic intellectual disability (NS-ID or idiopathic) is a complex neurodevelopmental disorder that represents a global health issue. Although many efforts have been made to characterize it and distinguish it from syndromic intellectual disability (S-ID), the highly heterogeneous aspect of this disorder makes it difficult to understand its etiology. Long noncoding RNAs (lncRNAs) comprise a large group of transcripts that can act through various mechanisms and be involved in important neurodevelopmental processes. In this sense, comprehending the roles they play in this intricate context is a valuable way of getting new insights about how NS-ID can arise and develop. In this review, we attempt to bring together knowledge available in the literature about lncRNAs involved with molecular and cellular pathways already described in intellectual disability and neural function, to better understand their relevance in NS-ID and the regulatory complexity of this disorder.

Whole transcriptome analysis reveals correlation of long noncoding RNA ZEB1-AS1 with invasive profile in melanoma.

Melanoma is the deadliest form of skin cancer, and little is known about the impact of deregulated expression of long noncoding RNAs (lncRNAs) in the progression of this cancer. In this study, we explored RNA-Seq data to search for lncRNAs associated with melanoma progression. We found distinct lncRNA gene expression patterns across melanocytes, primary and metastatic melanoma cells. Also, we observed upregulation of the lncRNA ZEB1-AS1 (ZEB1 antisense RNA 1) in melanoma cell lines. Data analysis from The Cancer Genome Atlas (TCGA) confirmed higher ZEB1-AS1 expression in metastatic melanoma and its association with hotspot mutations in BRAF (B-Raf proto-oncogene, serine/threonine kinase) gene and RAS family genes. In addition, a positive correlation between ZEB1-AS1 and ZEB1 (zinc finger E-box binding homeobox 1) gene expression was verified in primary and metastatic melanomas. Using gene expression signatures indicative of invasive or proliferative phenotypes, we found an association between ZEB1-AS1 upregulation and a transcriptional profile for invasiveness. Enrichment analysis of correlated genes demonstrated cancer genes and pathways associated with ZEB1-AS1. We suggest that the lncRNA ZEB1-AS1 could function by activating ZEB1 gene expression, thereby influencing invasiveness and phenotype switching in melanoma, an epithelial-to-mesenchymal transition (EMT)-like process, which the ZEB1 gene has an essential role.

Does breast feeding provide protection against acute appendicitis? A case-control study.

Breast feeding stimulates a more tolerant lymphoid tissue at the base of the appendix and this could provide protection against acute appendicitis. Two studies reported that children and adolescents with appendicitis were less likely to have been breast fed. In a case-control study of 200 children with histologically confirmed acute appendicitis matched by 200 siblings with the same sex and difference age - up to three-year-old - we found breast feeding in at least the first two months of life and for more than four months provides protection against acute appendicitis. These findings suggesting that breast feeding may possibly give protection against the development of appendicitis.

"What do we know about regulatory T cells and endometriosis? A systematic review".

Endometriosis is a benign, chronic inflammatory disease that presents alterations in immune response that can be detected in eutopic endometrium, peritoneal fluid and peripheral blood of affected women. Regulatory T (TReg) cells are a subpopulation of T lymphocytes specialized in immune regulation that seem to participate in the development of endometriosis, by suppressing the immune response and favoring the establishment of lesions. Our aim was to review the scientific literature that evaluates TReg cell phenotypes in the context of endometriosis. PRISMA statement for systematic reviews was applied, using "regulatory T cells" and "endometriosis" as keywords in the following databases: PubMed, Cochrane, EMBASE and Lilacs. The initial search and abstract review yielded 41 papers relating to the subject. At the end, 12 studies, published between 2009 and 2016, were included. Most studies that analyzed TReg cells did not characterize these cells with current Bona Fide markers. In peritoneal fluid and endometriotic lesions, there was a higher concentration of TReg cell phenotype and/or TReg cell expression markers in patients with endometriosis when compared with controls. However, there is still not a consensus about TReg cells concentration in eutopic endometrium and peripheral blood between the revised studies. Taken together, this data collection suggests that endometriosis is related to TReg cells alterations, although further studies are necessary to reach more precise conclusions, especially regarding the percentage of these cells in eutopic endometrium and peripheral blood. This systematic review attempted to provide instructive and up-to-date collection of data that may help better design future studies.

Tratamento de pênfigo vulgar com imunoglobulina humana como adjuvante ao corticoide oral: um relato de caso / Pemphigus vulgaris treatment with human immunoglobulin as adjuvant to oral corticoid: a case report

Introdução: o pênfigo vulgar é uma doença de caráter autoimune, que leva à formação de bolhas locais ou generalizadas causadas pelo ataque de autoanticorpos às estruturas da epiderme. A terapêutica Recebido em: 25/09/2018 com imunoglobulina humana como adjuvante é uma excelente opção para os casos em que há resistência ao tratamento habitual, além de poder diminuir o tempo de tratamento com imunossupressores. Objetivo: descrever um relato de caso sobre um paciente portador de pênfigo vulgar submetido ao tratamento com imunoglobulina humana como adjuvante ao corticoide oral. Relato do caso: paciente 49 anos, foi internado apresentando lesões erosivas em mucosa oral e conjuntival, com piora sistêmica após início de tratamento com antibióticos e anti-inflamatório. Inicialmente realizou-se o tratamento convencional com corticoterapia, porém sem resultados satisfatórios. Devido ao agravamento da clínica, e ao estabelecimento do diagnóstico de pênfigo vulgar, foi incluída no tratamento a imunoglobulina humana como adjuvante, o que culminou em uma melhora progressiva do paciente. Conclusão: apesar de o tratamento do pênfigo vulgar ter os corticoides como primeira opção, é importante conhecer tratamentos adjuvantes e/ou alternativos, como as imunoglobulinas humanas, para auxiliar no tratamento dos pacientes que não respondem ao corticoide.

Introduction: Pemphigus Vulgaris is an autoimmune disease that leads to the formation of local or generalized blisters as a result of autoantibodies against epidermal structures. Therapy with human immunoglobulin as an adjuvant is an excellent option for cases where there is resistance to usual treatment, in addition to being able to reduce the time of treatment with immunosuppressant. Thus, it is an alternative treatment for patients with severe infections or immunological deficiencies. Aim: to describe a case report about a carrier patient of pemphigus vulgaris treated with human immunoglobulin as adjuvant to oral corticosteroids. Case report: patient with 49 years old, was hospitalized in the city of Belo Horizonte (MG) presenting erosive lesions in the oral and conjunctival mucosa, with systemic worsening after starting treatment with antibiotics and anti-inflammatory. Initially, conventional steroid therapy was performed, but with no satisfactory results. Due to worsening symptoms and the diagnosis of Pemphigus Vulgaris, human immunoglobulin was included in the treatment as an adjuvant, which resulted in a progressive improvement of the patient. Conclusion: although treatment of Pemphigus Vulgaris has steroids as the first option, it is vital that the physician knows adjuvant and/or alternative therapies, such as human immunoglobulins, to assist in the treatment of patients who do not respond to steroids.

Avaliação do quadro clínico e perfil bioquímico de bovinos durante indução e tratamento de hipocalcemia / Assessment of clinical and biochemical profile of cattle during induction and treatment of hypocalcemia

O presente trabalho objetivou estudar o quadro sintomatológico, algumas variáveis bioquímicas e a resposta ao tratamento com cálcio de bovinos com hipocalcemia induzida experimentalmente. Foram utilizadas 12 novilhas distribuídas nos grupos controle (n = 5) e tratado (n = 7). Foi infundida solução de EDTA a 5% até o animal apresentar sinais clínicos de hipocalcemia, quando então era iniciado o tratamento com solução contendo cálcio, fósforo, magnésio e glicose, na dose de 1 mL/kg/PV, em 30 minutos, enquanto que o grupo controle recebia apenas solução fisiológica na mesma dose. Exame clínico e coleta de amostras sanguíneas foram realizados nos tempos T0 (basal), T1 (Fase I, caracterizada por tremores musculares), T2 (ao final da infusão com EDTA), T3 (ao final do tratamento) e T4 (24 horas após o término do experimento). Todas as novilhas mostraram diminuição temporária da concentração de cálcio total e livre, fósforo, e apresentaram quadro clássico de hipocalcemia. A taquicardia, a hipofonese e a atonia ruminal desapareceram no decorrer do tratamento, sendo observado aumento no cálcio livre e total e fósforo. O medicamento usado no tratamento dos animais foi eficaz na recuperação do quadro clínico de hipocalcemia dentro de 30 minutos, promovendo retorno das principais variáveis do perfil bioquímico aos valores basais

The present work aims to study the clinical picture, biochemical profile and treatment response in cattle with induced hypocalcaemia. Were utilized 12 heifers randomly distributed in treated (n = 7) and control (n = 5) groups. The induction model was carried on by continuous EDTA infusion into jugular vein until the animals present clinical signs of hypocalcaemia. After that, the treated group received a calcium (Ca) solution enriched with phosphorus, magnesium and glucose with a dose of 1 mL/kg/BW in 30 minutes, meanwhile, the control group was treated with the same dose of physiologic solution. Clinical examination were performed and blood samples were obtained in times T0 (basal time), T1 (beginning of hypocalcaemia); T2 (end of EDTA infusion); T3 (end of treatment) and T4 (24 hours after the induction). All the heifers present temporary blood calcium and phosphorus reduction and demonstrated classical clinical picture of hypocalcaemia. The treated group present full clinical recovery and blood calcium and phosphorus increase. Most evident clinical signs were increasing heart beat, hypophonesis and rumenal atony. Those symptoms were reversed after calcium treatment. The solution used for treatment was efficient on clinical recovery within thirty minutes, promoting the return to basal levels of the most of biochemical's variables