SOFRIMENTO E CONTRADIÇÃO: O SIGNIFICADO DA MORTE E DO MORRER PARA ENFERMEIROS QUE TRABALHAM NO PROCESSO DE DOAÇÃO DE ÓRGÃOS PARA TRANSPLANTE

Objectives: To identify the perception and the sentiments of the nurses, in relation to death and dying, who work with the harvesting of organs for transplant. Methods: This is a descriptive research utilizing a qualitative approach. Ten (10) semi-structured interviews were performed, recorded on video-cassette, and the data were analyzed following the analysis of the speeches according to Bardin. Results: Three categories emerged: Category 1 – The significance of death is represented by the following subcategories: Finality, Rebirthing and Contradiction; Category 2 – The significance of donation, is represented by the following subcategories: Solidarity and Generosity, Chance of Life and Contradiction; Category 3 – Existing conflicts among nurses who work in the process of harvesting organs is represented by the following subcategories: Interpersonal relations with the family of the donator, caring for the donor in detriment of the donation, suffering at work, trying to maintain control, criticizing the process of harvesting organs and searching for meaning in their work. Conclusion: From analyzing the content according to the Bardin’s method of processing data, it can be inferred that professionals involved in harvesting organs need to be fully aware that they can compromise their own mental and physical health when encountering these frequent existential conflicts and moral dilemmas.Objetivo: Identificar la percepción y los sentimientos de los enfermeros que trabajan en la captación de órganos para trasplantes en relación a la muerte y al morir. Método: Trátase de una investigación descriptiva con abordaje cualitativo. Fueron realizadas 10 entrevistas semi-estructuradas, grabadas en cinta-cassette, y los datos discutidos a partir del análisis de los discursos según Bardin. Resultados: Emergieron tres categorías: Categoría 1 - El significado de la muerte, constituida por las subcategorías: Finitud, Renacimiento y Contradicción; Categoría 2 – El significado de la donación, con las subcategorías: Solidaridad y desprendimiento, Oportunidad de vida e Contradicción; Categoría 3 – Conflictos vivenciados por el enfermero en el proceso de trabajo en la captación de órganos, teniendo como subcategorías: Estando con la familia del donador, Cuidando del donador en detrimento de la donación, Sufriendo en el trabajo, Intentando preservarse, Criticando el proceso de captación y Buscando el sentido del trabajo. Conclusión: A partir del análisis de los contenidos según las orientaciones del método de proceso de datos de Bardin, podemos inferir que los profesionales de captación de órganos necesitan ser cuidados por vivenciar conflictos existenciales y dilemas morales con mucha frecuencia en sus quehaceres, pudiendo comprometer su propia salud mental y física.Objetivo: identificar a percepção e os sentimentos dos enfermeiros que trabalham na captação de órgãos para transplante em relação à morte e o morrer. Método: trata-se de uma pesquisa descritiva com abordagem qualitativa. Foram realizadas 10 entrevistas semi-estruturadas, gravadas em fita cassete, e os dados analisados a partir da análise dos discursos. Resultados: emergiram três categorias: Categoria 1 – O significado da morte, constituída pelas subcategorias: Finitude, Renascimento e Contradição; Categoria 2 – O significado da doação, com as subcategorias: Solidariedade e desprendimento, Chance de vida e Contradição; Categoria 3 – Conflitos vivenciados pelo enfermeiro no processo de trabalho na captação de órgãos, tendo como subcategorias: Estando com a família do doador, Cuidando do doador em detrimento a doação, Sofrendo no trabalho, Tentando preservar-se, Criticando o processo de captação e Buscando o sentido do trabalho. Conclusão: os profissionais de captação de órgãos necessitam ser cuidados por vivenciarem conflitos existenciais e dilemas morais com grande freqüência em seu fazer, podendo comprometer sua saúde mental e física

The resolution of acute inflammation induced by cyclic AMP is dependent on annexin A1

Annexin A1 (AnxA1) is a glucocorticoid-regulated protein known for its anti-inflammatory and pro-resolving effects. We have shown previously that the cAMP-enhancing compounds rolipram (ROL; a PDE4 inhibitor) and Bt2cAMP (a cAMP mimetic) drive caspase-dependent resolution of neutrophilic inflammation. In this follow-up study, we investigated whether AnxA1 could be involved in the pro-resolving properties of these compounds using a model of LPS-induced inflammation in BALB/c mice. The treatment with ROL or Bt2cAMP at the peak of inflammation shortened resolution intervals, improved resolution indices, and increased AnxA1 expression. In vitro studies showed that ROL and Bt2cAMP induced AnxA1 expression and phosphorylation, and this effect was prevented by PKA inhibitors, suggesting the involvement of PKA in ROL-induced AnxA1 expression. Akin to these in vitro findings, H89 prevented ROL- and Bt2cAMP-induced resolution of inflammation, and it was associated with decreased levels of intact AnxA1. Moreover, two different strategies to block the AnxA1 pathway (by using N-t-Boc-Met-Leu-Phe, a nonselective AnxA1 receptor antagonist, or by using an anti-AnxA1 neutralizing antiserum) prevented ROL- and Bt2cAMP-induced resolution and neutrophil apoptosis. Likewise, the ability of ROL or Bt2cAMP to induce neutrophil apoptosis was impaired in AnxA-knock-out mice. Finally, in in vitro settings, ROL and Bt2cAMP overrode the survival-inducing effect of LPS in human neutrophils in an AnxA1-dependent manner. Our results show that AnxA1 is at least one of the endogenous determinants mediating the pro-resolving properties of cAMP-elevating agents and cAMP-mimetic drug

Functional markers for gene mapping and genetic diversity studies in sugarcane

<p>Abstract</p> <p>Background</p> <p>The database of sugarcane expressed sequence tags (EST) offers a great opportunity for developing molecular markers that are directly associated with important agronomic traits. The development of new EST-SSR markers represents an important tool for genetic analysis. In sugarcane breeding programs, functional markers can be used to accelerate the process and select important agronomic traits, especially in the mapping of quantitative traits loci (QTL) and plant resistant pathogens or qualitative resistance loci (QRL). The aim of this work was to develop new simple sequence repeat (SSR) markers in sugarcane using the sugarcane expressed sequence tag (SUCEST database).</p> <p>Findings</p> <p>A total of 365 EST-SSR molecular markers with trinucleotide motifs were developed and evaluated in a collection of 18 genotypes of sugarcane (15 varieties and 3 species). In total, 287 of the EST-SSRs markers amplified fragments of the expected size and were polymorphic in the analyzed sugarcane varieties. The number of alleles ranged from 2-18, with an average of 6 alleles per locus, while polymorphism information content values ranged from 0.21-0.92, with an average of 0.69. The discrimination power was high for the majority of the EST-SSRs, with an average value of 0.80. Among the markers characterized in this study some have particular interest, those that are related to bacterial defense responses, generation of precursor metabolites and energy and those involved in carbohydrate metabolic process.</p> <p>Conclusions</p> <p>These EST-SSR markers presented in this work can be efficiently used for genetic mapping studies of segregating sugarcane populations. The high Polymorphism Information Content (PIC) and Discriminant Power (DP) presented facilitate the QTL identification and marker-assisted selection due the association with functional regions of the genome became an important tool for the sugarcane breeding program.</p

Experience of nurses in the process of donation of organs and tissues for transplant

OBJETIVO: conhecer o significado da ação de enfermeiros no processo de doação para viabilizar órgãos e tecidos para transplante. MÉTODO: pesquisa qualitativa, com abordagem da Fenomenologia Social, foi realizada por meio de entrevistas individuais com dez enfermeiros de três Serviços de Procura de Órgãos e Tecidos da cidade de São Paulo. RESULTADOS: a vivência dos enfermeiros no processo de doação foi representada pelas categorias: obstáculos vivenciados no processo de doação e intervenções realizadas. O significado da ação para viabilizar órgãos e tecidos para transplante foi descrito pelas categorias: mudar paradigmas, humanizar o processo de doação, aumentar a doação e salvar vidas. CONSIDERAÇÕES FINAIS: o conhecimento da vivência dos enfermeiros nesse processo oferece subsídios aos profissionais de saúde, que atuam em diferentes realidades, sinalizando estratégias para otimizar a obtenção de órgãos e tecidos para transplante.OBJECTIVE: to investigate the meaning of the action of nurses in the donation process to maintain the viability of organs and tissues for transplantation. METHOD: this qualitative study with a social phenomenological approach was conducted through individual interviews with ten nurses of three Organ and Tissue Procurement Services of the city of São Paulo. RESULTS: the experience of the nurses in the donation process was represented by the categories: obstacles experienced in the donation process, and interventions performed. The meaning of the action to maintain the viability of organs and tissues for transplantation was described by the categories: to change paradigms, to humanize the donation process, to expand the donation, and to save lives. FINAL CONSIDERATIONS: knowledge of the experience of the nurses in this process is important for healthcare professionals who work in different realities, indicating strategies to optimize the procurement of organs and tissues for transplantation.OBJETIVO: conocer el significado de la acción de enfermeros en el proceso de donación órganos y tejidos para dar viabilidad al trasplante. MÉTODO: investigación cualitativa, con abordaje de la Fenomenología Social, fue realizada por medio de entrevistas individuales con diez enfermeros de tres Servicios de Búsqueda de Órganos y Tejidos de la ciudad de Sao Paulo. RESULTADOS: la vivencia de los enfermeros en el proceso de donación fue representada por las categorías: obstáculos experimentados en el proceso de donación e intervenciones realizadas. El significado de la acción para dar viabilidad al proceso trasplante de órganos y tejidos fue descrito por las categorías: cambiar paradigmas, humanizar el proceso de donación, aumentar la donación y salvar vidas. CONSIDERACIONES FINALES: el conocimiento de la vivencia de los enfermeros en ese proceso ofrece informaciones importantes a los profesionales de salud que actúan en diferentes realidades, señalando estrategias para optimizar la obtención de órganos y tejidos para trasplante

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe