Simulação realística em enfermagem: a experiência discente enquanto vítima de trauma em desafio

Introdução: Compreende-se como APH  um serviço prestado que abrange intervenções perante cenas que causam risco iminente à vida, esta assistência prévia pode minimizar as taxas de morbimortalidade antecedente à chegada em uma unidade hospitalar. Objetivos: Descrever as experiências vivenciadas por acadêmicos sob a perspectiva de atuarem como vítimas no 1° Desafio Sul-Mato Grossense de Salvamento Veicular e Trauma. Metodologia: Relato de experiência descritivo, realizado a partir da vivência de estudantes de uma liga acadêmica de enfermagem, que participaram como vítimas realísticas, no 1º Desafio Sul-Mato-Grossense de Salvamento Veicular e Trauma.  Resultados: Os manequins vivos obtiveram maior aprendizado, pois, participaram da simulação de forma direta, sem ter o sentimento de nervosismo ou estar disperso com a vibração da torcida, e o mais importante observaram de outro ângulo, no qual remete a visão de uma vítima real e sentir vivência de receber um atendimento de diferentes profissionais em diferentes situações. Discussão: Para que seja realizado um atendimento de qualidade, as formações acadêmicas devem estar de acordo com o que exige do profissional em campo, pode-se visualizar a necessidade de relacionar a teoria com a prática, bem como o preparo físico e psicológico, agilidade e perfil para atuar no APH. Considerações finais: vivenciar o atendimento inicial à vítima de trauma, promove em alunos a oportunidade de acompanhar e solucionar o que era proposto de acordo com o caso evidenciado, bem como desenvolver visão crítica para a resolução dos problemas

HEMANGIOMAS E HEMANGIOSSARCOMAS EM CÃES: ESTUDO RETROSPECTIVO DE 192 CASOS (2002-2014)

O hemangioma e o hemangiossarcoma são neoplasias mesenquimais originárias do endotélio vascular e o cão é o animal doméstico mais frequentemente acometido. Os registros do Laboratório de Patologia Animal do Hospital Veterinário da Universidade Federal de Uberlândia de 2002 a 2014 foram revisados. Os dados epidemiológicos e a frequência de cães com diagnóstico de hemangioma e hemangiossarcoma foram verificados e estatisticamente comparados. Foram identificados 64 casos de hemangioma e 128 casos de hemangiossarcoma. Para os hemangiomas, não houve diferença na frequência de acordo com sexo e raça. Quanto à localização, os hemangiomas não viscerais foram os mais frequentes em relação aos viscerais. As cadelas e animais adultos e idosos foram frequentemente acometidos por hemangiossarcoma, assim como a raça Pitbull. Os hemangiossarcomas apresentaram predominantemente tamanho médio e localização cutânea, ou seja, não visceral. Palavras-chave: cão; endotélio vascular; neoplasia

Regulation of Stress-Inducible Phosphoprotein 1 Nuclear Retention by Protein Inhibitor of Activated STAT PIAS1

Stress-inducible phosphoprotein 1 (STI1), a cochaperone for Hsp90, has been shown to regulate multiple pathways in astrocytes, but its contributions to cellular stress responses are not fully understood. We show that in response to irradiation-mediated DNA damage stress STI1 accumulates in the nucleus of astrocytes. Also, STI1 haploinsufficiency decreases astrocyte survival after irradiation. Using yeast two-hybrid screenings we identified several nuclear proteins as STI1 interactors. Overexpression of one of these interactors, PIAS1, seems to be specifically involved in STI1 nuclear retention and in directing STI1 and Hsp90 to specific sub-nuclear regions. PIAS1 and STI1 co-immunoprecipitate and PIAS1 can function as an E3 SUMO ligase for STI. Using mass spectrometry we identified five SUMOylation sites in STI1. A STI1 mutant lacking these five sites is not SUMOylated, but still accumulates in the nucleus in response to increased expression of PIAS1, suggesting the possibility that a direct interaction with PIAS1 could be responsible for STI1 nuclear retention. To test this possibility, we mapped the interaction sites between PIAS1 and STI1 using yeast-two hybrid assays and surface plasmon resonance and found that a large domain in the N-terminal region of STI1 interacts with high affinity with amino acids 450-480 of PIAS1. Knockdown of PIAS1 in astrocytes impairs the accumulation of nuclear STI1 in response to irradiation. Moreover, a PIAS1 mutant lacking the STI1 binding site is unable to increase STI1 nuclear retention. Interestingly, in human glioblastoma multiforme PIAS1 expression is increased and we found a significant correlation between increased PIAS1 expression and STI1 nuclear localization. These experiments provide evidence that direct interaction between STI1 and PIAS1 is involved in the accumulation of nuclear STI1. This retention mechanism could facilitate nuclear chaperone activity. Molecular & Cellular Proteomics 12: 10.1074/mcp.M113.031005, 3253-3270, 2013

Research of mammary tumors in female dogs in Uberlândia and cyclooxygenase 2 immunostaining

The cyclooxygenase 2 (Cox 2) is a molecular indicator of prognosis marker and its expression is associated with progression of mammary tumors in dogs. The purpose of this study was to investigate breast tumors of bitches Cox 2 expression by immunohistochemistry and correlated with the clinical stage, tumor size, lymph node involvement, the classification and the histological grade of carcinomas. We included in this study, 100 female dogs with mammary tumors and 131 samples were analyzed. Histological and COX 2 immunostaining evaluation were conducted. The streptavidin-biotinaperoxidase technique was used in order to do the immunohistochemistry (IHC). The IHC analysis was performaced counting the number of positive-staining cells in ten fields and the staining intensity. The COX 2 staining index was obtained by multiplying the COX 2 staining distribution and intensity scores. This gave a range of COX 2 staining indices of 0 12.Carcinoma complex was the most common histological type that we were diagnosed. The COX 2 expression was observed in the benign and malignant tumors. The weak score is more frequent, and strong score was observed in carcinomas. Simple carcinomas demonstraded a higher number of positive staining cells. There was no positive correlation between the histological type, size and lymph node involvement and the Cox 2 immunostaining. Therefore, COX 2 immunostaining is not a good prognostic factor.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorMestre em Ciências VeterináriasA ciclooxigenase 2 (Cox 2) é um marcador molecular indicador de prognóstico e sua expressão está relacionada com a progressão do tumor mamário na cadela. Tendo isso em vista, o objetivo deste trabalho foi investigar tumores mamários de cadelas a expressão de Cox 2 por meio de imunohistoquímica e correlacionar com o estadiamento clínico, o tamanho tumoral, o envolvimento linfonodal, a classificação e o grau histológico dos carcinomas. Foram incluídas neste estudo, 100 cadelas com neoplasia mamária e dessas, 131 amostras foram analisadas. A avaliação histológica e da imunomarcação de Cox 2 foram conduzidas. Para a imunohistoquímica (IHQ), utilizou-se a técnica de estreptoavidina-biotinaperoxidase. Para análise das lâminas de IHQ contou-se o número de células marcadas em dez campos e verificou-se a intensidade de marcação. O escore de marcação foi obtido pelo produto do número de células marcadas e a intensidade de marcação. O tipo histológico mais frequente diagnosticado foi o carcinoma complexo mamário. A expressão de Cox 2 foi observada nos tumores benignos e malignos. A marcação fraca é mais frequente, sendo a marcação forte observada nos carcinomas. Os carcinomas simples apresentaram maior número de células marcadas. Não houve correlação positiva entre o tipo histológico, tamanho e o envolvimento linfonodal e a imunomarcação de Cox 2. Sendo assim, a imunomarcação de Cox 2 não demonstrou ser um bom fator de prognóstico

Molecular immunophenotype of canine mammary carcinomas and the relationship with prognostic factors and survival

Neoplasias are the most common affections in dogs, and the spontaneous mammary tumors are the most frequent in female bitches. More than 50% of the cases are malignant and it represent a heterogeneity disease group with variable morphology and biological behavior. Molecular expression of estrogen receptors (ER) and progesterone receptors (PR) are considered prognostic factors, and ER expression is essential for determination of molecular classification. Another molecular marker frequently evaluated in human breast cancer is type 2 human epidermal growth factor (HER2). 84 bitches were included in this study. The radiographic and ultrasound examination were performed in orden to verify metastases in lung and nodal metastases. The surgical excision was a treatment for the mammary tumor (total or bilateral unilateral mastectomy). Samples of mammary neoplasms were evaluated for histological type and the expression of ER, PR e HER2 by immunohistochemistry. Evaluation of total overall survival (OS), disease-free interval (DFS) and time to tumor development in remaining breast (TDTMR) was performed. ST was defined as time after mastectomy up to the date of death; the DFS was the time after mastectomy until the development of recurrence or metastasis, and the TDTMR was determined as the time after mastectomy until the appearance of tumor in the remaining mammary gland. In the bitch, it is often expressed in malignant mammary carcinoma and correlates with nuclear pleomorphism, high histological grade and mitotic index, as well as lower survival. Absence of ER, PR and HER2 expression characterizes the triple negative phenotype. In women, this phenotype is related to aggressive tumor histology, poor prognosis, presence of metastases and recurrences. In bitch, they also present aggressive behavior, poor prognosis and reduction of survival. The objective of this study was to verify the expression of ER and the frequency of triple negative phenotype in canine mammary carcinomas (CMC) and correlate them with clinicopathological characteristics, overall survival (OS), disease-free interval and tumor development time in the breast remaining in bitches. In this study, the expression of estrogen was identified in 30.95% of canine mammary carcinomas, old-aged bitches, complex histological type grade II. Age was identified as a prognostic factor in canine mammary tumors and neoplasms of lower histological grade expressed more RE. The isolated evaluation of this molecular marker was not a good prognostic factor when considering total survival (483.42 ± 319.17 days) disease-free time (234.45 ± 241.05 days) and the time of tumor development in remaining mammary gland (279.68 ± 317.75 days). Furthermore, 21.43% of CMC were identified as a triple negative phenotype. None of the clinicopathological parameters evaluated (type and histological grade, clinical stages, stromal invasiveness, age, size and tumor location) differed significantly between the two CMC groups (triple negative and non triple negative), except for castration. In addition, we observed a correlation of this variable in the multivariate analysis with ST (471.42 ± 353.45 days). The behavior of the triple negative CMC seems to be less aggressive than in woman. The use of other molecular markers (Ki67, P53, P-caderina) must be used to distinguish the molecular subgroups in triple negative phenotype, and lead to the identification of more or less aggressive triple negative phenotypes. As similar CMC in general, castration may influence the occurrence of CMC triple negative.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorFAPEMIG - Fundação de Amparo a Pesquisa do Estado de Minas GeraisTese (Doutorado)As neoplasias estão entre as afecções mais comuns em cães, sendo que tumores mamários espontâneos são os mais frequentes em cadelas fêmeas. Mais de 50% dos casos são malignos e representam um grupo de grande heterogeneidade em termos de morfologia e comportamento biológico. A expressão molecular de receptores de estrógeno (RE) e receptores de progesterona (RP) são considerados fatores de prognóstico, sendo a expressão de RE essencial para determinação da caracterização molecular. Outro marcador molecular frequentemente avaliado em oncologia humana é o fator de crescimento epidérmico humano tipo 2 (HER2), na cadela, é frequentemente expresso em tumores mamários malignos e correlaciona-se com pleomorfismo nuclear, alto grau histológico e índice mitótico, além de menor sobrevida. A ausência de expressão de RE, RP e HER2 caracteriza o fenótipo triplo negativo. Na mulher este fenótipo está relacionado a histologia tumoral agressiva, prognóstico ruim, presença de metástases e recidivas. Na cadela também apresentam comportamento agressivo, prognóstico desfavorável e redução de sobrevida. Objetivou-se neste trabalho verificar a expressão de RE e a frequência do fenótipo triplo negativo em carcinomas mamários caninos (CMC) e correlacioná-las com características clinicopatológicas, sobrevida global (SG), intervalo livre de doença e tempo de desenvolvimento de tumor em mama remanescente em cadelas. Foram incluídas neste estudo 84 cadelas. Elas foram submetidas a exame radiográfico e de ultrassonografia, para avaliação de metástases pulmonares e a distância, e que realizaram exérese cirúrgica como tratamento para o tumor de mama (mastectomia unilateral total ou bilateral total). As amostras de neoplasias mamárias foram avaliadas quanto ao tipo e grau histológico, invasividade estromal, e a expressão de RE, RP e HER2 por meio de imunohistoquímica. Neste estudo, a expressão de estrógeno foi identificada em 30,95% de carcinomas mamários caninos, de cadelas idosas, tipo histológico complexo grau II. A idade foi identificada como fator de prognóstico nos tumores mamários de cadelas e neoplasias de menor grau histológico expressam mais RE. A avaliação isolada deste marcador molecular não foi um bom fator de prognóstico quando se considera sobrevida global (483,42 ±319,17 dias) tempo livre de doença (234,45 ±241,05 dias) e o tempo de desenvolvimento de tumor em mama remanescente (279,68 ±317,75 dias). Ainda, 21,43% dos CMC foram identificados como fenótipo triplo negativo. Nenhum dos parâmetros clinicopatológicos avaliados (tipo e grau histológico, estadios clínicos, invasividade estromal, idade, tamanho e localização tumoral) diferiram significativamente entre os dois grupos de CMC (triplo negativos e não triplo negativos), exceto a castração. Além disso, observou-se correlação desta variável, na análise multivariada, com a SG (471,42±353,45 dias). O comportamento dos CMC triplo negativo parece ser menos agressivo quando comparado com o da mulher. A utilização de outros marcadores moleculares, como Ki-67, P53, P-caderima, podem auxiliar na diferenciação de subgrupos moleculares dentro do fenótipo triplo negativo e levar à identificação de fenótipos triplo negativos mais ou menos agressivos. Assim como ocorre com CMC em geral, a castração pode influenciar na ocorrência de CMC triplo negativo

Retrospective Study of Mammary Lesions in Bitches - Uberlândia, MG, Brazil

Background: Mammary tumors are a type of neoplasia that are most commonly found in female dogs and are mostly malignant. The aim of this study, performed in the Laboratory of Veterinary Pathology of the Federal University of Uberlândia (LVP-FUU) from 2004 to 2014, was to determine the prevalence of mammary tumors in bitches and to verify the relationship between the epidemiological factors (age and breed) and clinicopathological aspects (ulceration, tumor size, and malignancy) in the occurrence of tumors.Materials, Methods & Results: A retrospective study was carried out using histopathological information retrieved from the LPV-UFU database. We collected the information on age and breed of female dogs, as well as about the location, macroscopic aspects, and histological diagnosis of mammary lesions. Only female dogs were considered for this study; a total of 911 histopathological protocols (with only one diagnosis) were analyzed along with 36 protocols that presented more than one diagnosis of mammary tumor. The age of animals ranged from one to 20 years, and the mean age was 9.99 years. The most affected breeds of dogs were: Cross breed (39.56% - 288/728) and Poodle (20.19% - 147/728). The inguinal glands were most affected by the malignant tumors (P < 0.05). A prevalence of tumors bigger than 5 cm in diameter (T3) was observed in the elderly animals (P = 0.0154) and in the inguinal mammary glands (P = 0.044). Simple carcinoma was the most frequent histological type.Discussion: Research shows that more than 40% of the tumors in bitches are located in the mammary glands, emphasizing the importance of this type of neoplasia in female dogs. Mammary tumors develop more frequently in the middle-aged and elderly bitches, with the highest occurrence being in the age range of 8 and 10 years, corroborating our observation in the present study that the mean age of bitches was 9.99 years. In this survey, a higher incidence was observed in mongrel bitches compared to that in the Poodle breed. Some authors affirm that there is no racial predisposition for the occurrence of this pathology; however, a compilation of data suggests a predisposition of at least 10 breeds, with the involvement of an as yet unidentified genetic component. Of these, six breeds (Poodle, Cocker Spaniel, Pointer, Maltese, Yorkshire Terrier, and Dachshund) were found to be predisposed to mammary tumors in this study. The percentage (49.23%) of malignant tumors found in the inguinal glands is consistent with the findings reported in literature, and might be associated with a greater amount of parenchyma, abundance of hormone receptors in these glands, and vascularization provided by the caudal superficial epigastric artery and vulvar branches of external pudendal artery. Tumor size is considered to be a prognostic factor and tumors  ≤ 3 cm in diameter  (T1) have a better prognosis. Consequently, the prevalence of tumors  ≥ 5 cm in diameter  (T3) in elderly animals is probably related to malignancy of the lesions, because tumors usually progress to a worse histological grade with time. The higher occurrence of T3 in inguinal glands might be related to the abundance of parenchyma and/or hormonal receptors in them. As in the present study, data from literature refer to the superiority of malignant histological types, with prevalence varying between 68 and 91%. When prolonged, the time between the onset of tumor and clinical evaluation may be a determinant in the progression from benign to malignant tumors. Among the malignant neoplasms, simple carcinoma was observed to be prevalent, followed by mixed tumors with carcinoma, in agreement with the results of several studies. It is concluded that mammary tumors are more prevalent in older mongrel dogs and Poodle. Attention should be paid to inguinal mammary tumors, because these are mainly malignant

Prognostic Factors in Canine Mammary Carcinomas and HER2 Expression Relationship

Background: The human epidermal growth factor type 2 (HER2) receptor is a membrane glycoprotein tyrosine kinase. In woman, HER2 expression is diagnosed in 30% of breast carcinomas and it is associated with a worse prognosis, higher rate of recurrence and mortality. In the bitch, the HER2 overexpression in canine mammary tumors is still controversial and the prognostic value remains uncertain. Thus, we aimed to verify the HER2 expression in canine mammary carcinomas and relate it to the type and histological grade, lymph node metastasis and clinical staging.Materials, Methods &amp; Results: Ninety bitches diagnosed with mammary carcinoma were included in this study. The inclusion criteria were bitches with complete clinical examination, thoracic radiographic examination and submitted unilateral or bilateral mastectomy. Ninety-nine samples of mammary carcinoma were used and the fragments of tumor and regional lymph nodes were fixed in 10% neutral formalin for histopathological and immunohistochemistry analysis. The lesions were evaluated by two pathologists and classified according to the type and histological grade. HER2 expression was performed by semi-quantitative analysis of the slides according to the HerceptTestTM (Dako) recommended score. Simple carcinomas were the most frequent (51.51%) followed by complex carcinomas (46.47%) and in situ carcinoma (2.02%). The histological grade of 97 carcinoma samples was attributed, except in situ carcinoma, 37 (38.14%) of the neoplasms were grade I, 50 (51.55%) grade II and only 10 (10.31%) tumors were classified as grade III. Forty bitches were submitted to clinical staging (TNM) and 42.50% of the bitches received staging in grade I and, 25% of the bitches staged in grade IV and V, with metastases. The HER2 expression, 13/99 samples (13.13%) received score +2, 19/99 (19.19%) score +1 and absence of marking (score 0) was identified in 67 samples (67.80 %). Immunostaining in hyperplastic or normal epithelial cells was evidenced, often in association with weak or moderate cytoplasmic labeling. Of the samples expressing +2 score for HER2 (n = 13), eight samples (17.39%) were complex carcinoma and five (9.80%) simple carcinomas. There was no relationship between HER2 immunostaining with age, tumor size, TNM, histological type, histological gradation, lymph node metastasis and distance. Animals with lymph node metastasis, as well as those diagnosed with distant metastasis, did not present HER2 expression in the tumors.Discussion: The simple carcinoma seems to be the most frequent type histological diagnosed in canine mammary carcinomas, followed by carcinoma in mixed tumor and complex carcinoma. Tubulopapillary carcinomas are more invasive in the female dogs as well as in the woman. Carcinomas grade I and II are more frequent and present a better prognosis for the dog. However, bitches with grade III carcinoma survived for a shorter time when compared to dogs with grade I or II tumors. A factor that may have contributed to the lower number of bitches at worst prognostic stage (EC IV and V) is the current owners’ awareness that they have sought veterinary help earlier, as soon as they detect small nodules in mammary gland. Overexpression of HER2 in women breast cancer is diagnosed in 20-30% of cases, whereas in bitches, this expression is variable. Also the different percentages of canine HER2 immunostaining are due to the lack of standardization for the analysis of the immunostaining, the immunohistochemical techniques employed and the non-specificity of the HER2 antibody. In canine mammary carcinomas the HER2 expression in low and this immunostaining is not related to other established prognostic factors. This study reinforces the hypothesis put forward by other authors that in the bitch the expression of HER2 may not be related to malignancy and tumor progression

Prognostic Factors in Canine Mammary Carcinomas and HER2 Expression Relationship

Background: The human epidermal growth factor type 2 (HER2) receptor is a membrane glycoprotein tyrosine kinase. In woman, HER2 expression is diagnosed in 30% of breast carcinomas and it is associated with a worse prognosis, higher rate of recurrence and mortality. In the bitch, the HER2 overexpression in canine mammary tumors is still controversial and the prognostic value remains uncertain. Thus, we aimed to verify the HER2 expression in canine mammary carcinomas and relate it to the type and histological grade, lymph node metastasis and clinical staging.Materials, Methods & Results: Ninety bitches diagnosed with mammary carcinoma were included in this study. The inclusion criteria were bitches with complete clinical examination, thoracic radiographic examination and submitted unilateral or bilateral mastectomy. Ninety-nine samples of mammary carcinoma were used and the fragments of tumor and regional lymph nodes were fixed in 10% neutral formalin for histopathological and immunohistochemistry analysis. The lesions were evaluated by two pathologists and classified according to the type and histological grade. HER2 expression was performed by semi-quantitative analysis of the slides according to the HerceptTestTM (Dako) recommended score. Simple carcinomas were the most frequent (51.51%) followed by complex carcinomas (46.47%) and in situ carcinoma (2.02%). The histological grade of 97 carcinoma samples was attributed, except in situ carcinoma, 37 (38.14%) of the neoplasms were grade I, 50 (51.55%) grade II and only 10 (10.31%) tumors were classified as grade III. Forty bitches were submitted to clinical staging (TNM) and 42.50% of the bitches received staging in grade I and, 25% of the bitches staged in grade IV and V, with metastases. The HER2 expression, 13/99 samples (13.13%) received score +2, 19/99 (19.19%) score +1 and absence of marking (score 0) was identified in 67 samples (67.80 %). Immunostaining in hyperplastic or normal epithelial cells was evidenced, often in association with weak or moderate cytoplasmic labeling. Of the samples expressing +2 score for HER2 (n = 13), eight samples (17.39%) were complex carcinoma and five (9.80%) simple carcinomas. There was no relationship between HER2 immunostaining with age, tumor size, TNM, histological type, histological gradation, lymph node metastasis and distance. Animals with lymph node metastasis, as well as those diagnosed with distant metastasis, did not present HER2 expression in the tumors.Discussion: The simple carcinoma seems to be the most frequent type histological diagnosed in canine mammary carcinomas, followed by carcinoma in mixed tumor and complex carcinoma. Tubulopapillary carcinomas are more invasive in the female dogs as well as in the woman. Carcinomas grade I and II are more frequent and present a better prognosis for the dog. However, bitches with grade III carcinoma survived for a shorter time when compared to dogs with grade I or II tumors. A factor that may have contributed to the lower number of bitches at worst prognostic stage (EC IV and V) is the current owners’ awareness that they have sought veterinary help earlier, as soon as they detect small nodules in mammary gland. Overexpression of HER2 in women breast cancer is diagnosed in 20-30% of cases, whereas in bitches, this expression is variable. Also the different percentages of canine HER2 immunostaining are due to the lack of standardization for the analysis of the immunostaining, the immunohistochemical techniques employed and the non-specificity of the HER2 antibody. In canine mammary carcinomas the HER2 expression in low and this immunostaining is not related to other established prognostic factors. This study reinforces the hypothesis put forward by other authors that in the bitch the expression of HER2 may not be related to malignancy and tumor progression