Mit Musik gebären - es ist Zeit aufzuklären : die Wirkung von Musiktherapie auf das Schmerz- und Angsterleben der Gebärenden

Darstellung des Themas: Frauen werden bei der Geburt mit starken Schmerzen und Ängsten konfrontiert. Da jedoch kein Medikament vollkommen frei von Risiken und Nebenwirkungen für Mutter und Kind ist, besteht eine grosse Nachfrage an alternativen Linderungsmitteln. Trotzdem rücken einige alternative Bewältigungsstrategien, mitunter der Musiktherapie, in der Hebammenarbeit in den Hintergrund. Ziel: Das Ziel ist es aufzuzeigen, welche Wirkung die individuell ausgewählte Musik der Erstgebärenden auf ihr Schmerz- und Angsterleben während ihrer Eröffnungsperiode hat. Des Weiteren soll dieser Mehrwert an Erkenntnissen in der Hebammenarbeit umgesetzt werden. Folglich kann die Erstgebärende über eine zusätzliche alternative Methode unter der Geburt informiert und beraten werden. Methode: Diese Arbeit hat das Design eines Literaturreviews. Nach ausgiebiger Literaturrecherche werden fünf Publikationen miteinander verglichen, kritisch gewürdigt und diskutiert. Relevante Ergebnisse: Das Angsterleben sowie die Schmerzintensität der Erstgebärenden werden in der Eröffnungsperiode durch die Musiktherapie gesenkt. Schlussfolgerung: Durch diese Resultate können Frauen durch Hebammen über eine zusätzliche alternative Methode in der Geburtshilfe evidenzbasiert beraten und aufgeklärt werden. Zudem ist die Musiktherapie einfach anzuwenden und kostengünstig. Es benötigt weiterführende Forschung, um die Wirkung der Musik bei Frauen zu ermitteln, welche ihre eigene Musikauswahl zur Geburt mitbringen

Biologia celular, interaçoes micelianas e cultivo de Lepista sordida

Orientadora: Ruth J. G. SchadeckCoorientador: Marco RandiMonografia (Bacharelado) - Universidade Federal do Paraná. Setor de Ciencias Biológicas. Curso de Graduaçao em Ciencias BiológicasResumo : Foram estudados os aspectos da biologia celular, interações micelianas bem como o cultivo, em Lepista sordida. Foram realizados: 1. experimentos de microscopia eletrônica de varredura (MEV) em Iam elas retiradas de basidiomas frescos e em hifas; 2. estudos citológicos com o corante vital Vermelho Nilo e Laranja de Acridina em hifas e esporos; 3. experimentos de interação miceliana entre isolados de L. sordida ePleurotus pulmonarius em BDA e MEA 2%; 4. experimentos de cultivo utilizando-se tratamento anaeróbio do substrato. Os resultados obtidos foram: 1. caracterização morfológica das hifas em MEV, bem como de suaslamelas, que apresentaram estruturas celulares comobasidiolos e basidiósporo. Neste último verificou-se a morfologia rugosa-verruculosa de sua parede celular; 2. utilizando-se o corante vital Vermelho Nilo, constatou-se em muitos dos esporos um único corpo lipídico no seu interior. Com o corante Laranja de Acridina também se observou que os basidiósporos que apresentavam uma quantidade menor de lipídio, possuiam vacúolos ácidos no seu citoplasma, com provável digestão lipídica nos seus interiores. Concomitante com o aparecimento dos vacúolos há um aumento do volume nuclear, uma vez que este se encontrava achatado pela presença de um grande corpo lipídico e, também, por apresentarem elevada taxa metabólica. As hifas também revelaram a presença destas estruturas celulares no citoplasma pelas mesmas técnicas citológicas. 3. Experimentos de interação miceliana entre isolados deL. sordida ePleurotus pulmonarius averiguaram as estratégias de combate que estes possuem. Quando colocados para interagir em BDA, P. pulmonarius substituiu totalmente L. sordida, apresentando cordas micelianas em alguns casos. Quando inoculados em MEA 2%, houve tanto a mesma substituição quanto o impasse (ausência de substituição). Neste meio verificou-se que, quando a taxa de.crescimento radial deP.pulmonariusera consideravelmente maior, a barreira de confronto formava,.se a seu favor,1'esultando em substituição. Quando as taxas eram semelhantes, a barreira ocorria praticamente na região central da placa de Petri, com L. sordida também avançando em alguns casos sobre o antagonista. 4. Nos estudos de cultivo utilizando o tratamento anaeróbio do substrato, o desenvolvimento miceliano apresentou-se positivo. No cultivo em ambientes controlados, constatou-se que a infra-estrutura disponível não era suficiente para as frutificações ocorrerem,sendo os substratos colonizados, portanto, transferidos para seus ambientes naturais, ou seja, gramados. O micélio destes experimentos se expandiu a partir do substrato para o solo ao seu redor. Esta técnica tem como um de seus principais objetivos a micorremediação de áreas degradadas e/ou poluídas

PPAR-Targeted Therapies in the Treatment of Non-Alcoholic Fatty Liver Disease in Diabetic Patients.

Peroxisome proliferator-activated receptors (PPAR), ligand-activated transcription factors of the nuclear hormone receptor superfamily, have been identified as key metabolic regulators in the liver, skeletal muscle, and adipose tissue, among others. As a leading cause of liver disease worldwide, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) cause a significant burden worldwide and therapeutic strategies are needed. This review provides an overview of the evidence on PPAR-targeted treatment of NAFLD and NASH in individuals with type 2 diabetes mellitus. We considered current evidence from clinical trials and observational studies as well as the impact of treatment on comorbid metabolic conditions such as obesity, dyslipidemia, and cardiovascular disease. Future areas of research, such as possible sexually dimorphic effects of PPAR-targeted therapies, are briefly reviewed

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort

OBJECTIVES To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). METHODS We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. RESULTS Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). CONCLUSIONS Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

NOSSO BAIRRO EM PAUTA: O ENCONTRO DA UNIVERSIDADE, ESCOLA PÚBLICA E COMUNIDADE

Universidade FEEVAL

Nursing Care of Patients With Cirrhosis: The LiverHope Nursing Project

Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients' quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers

Investigating the Bivalve Tree of Life -- an exemplar-based approach combining molecular and novel morphological characters.

To re-evaluate the relationships of the major bivalve lineages, we amassed detailed morpho-anatomical, ultrastructural and molecular sequence data for a targeted selection of exemplar bivalves spanning the phylogenetic diversity of the class. We included molecular data for 103 bivalve species (up to five markers) and also analysed a subset of taxa with four additional nuclear protein-encoding genes. Novel as well as historically employed morphological characters were explored, and we systematically disassembled widely used descriptors such as gill and stomach ‘types’. Phylogenetic analyses, conducted using parsimony direct optimisation and probabilistic methods on static alignments (maximum likelihood and Bayesian inference) of the molecular data, both alone and in combination with morphological characters, offer a robust test of bivalve relationships. A calibrated phylogeny also provided insights into the tempo of bivalve evolution. Finally, an analysis of the informativeness of morphological characters showed that sperm ultrastructure characters are among the best morphological features to diagnose bivalve clades, followed by characters of the shell, including its microstructure. Our study found support for monophyly of most broadly recognised higher bivalve taxa, although support was not uniform for Protobranchia. However, monophyly of the bivalves with protobranchiate gills was the best-supported hypothesis with incremental morphological and/or molecular sequence data. Autobranchia, Pteriomorphia, Heteroconchia, Palaeoheterodonta, Archiheterodonta, Euheterodonta, Anomalodesmata and Imparidentia new clade ( = Euheterodonta excluding Anomalodesmata) were recovered across analyses, irrespective of data treatment or analytical framework. Another clade supported by our analyses but not formally recognised in the literature includes Palaeoheterodonta and Archiheterodonta, which emerged under multiple analytical conditions. The origin and diversification of each of these major clades is Cambrian or Ordovician, except for Archiheterodonta, which diverged from Palaeoheterodonta during the Cambrian, but diversified during the Mesozoic. Although the radiation of some lineages was shifted towards the Palaeozoic (Pteriomorphia, Anomalodesmata), or presented a gap between origin and diversification (Archiheterodonta, Unionida), Imparidentia showed steady diversification through the Palaeozoic and Mesozoic. Finally, a classification system with six major monophyletic lineages is proposed to comprise modern Bivalvia: Protobranchia, Pteriomorphia, Palaeoheterodonta, Archiheterodonta, Anomalodesmata and Imparidentia

Características epidemiológicas y desenlaces de la infección por SARS-CoV-2 en pacientes con patologías reumáticas: primer reporte del registro argentino SAR-COVID

Con el fin de evaluar el impacto de la infección por SARS-CoV-2 en pacientes con enfermedades reumáticas, la Sociedad Argentina de Reumatología desarrolló el Registro Nacional de Pacientes con Enfermedades Reumáticas y COVID-19 (SAR-COVID). El objetivo del presente trabajo fue evaluar las características sociodemográficas y clínicas de los pacientes con enfermedades reumáticas e infección por SARS-CoV-2 incluidos en el registro SAR-COVID y describir las complicaciones y desenlaces de la COVID-19 en esta población. Material y métodos: SAR-COVID es un registro nacional, multicéntrico y observacional, en el cual se incluyen de manera consecutiva pacientes ≥18 años de edad, con diagnóstico de alguna enfermedad reumática que hayan cursado infección por SARS-CoV-2. Se consignan datos sociodemográficos, comorbilidades, enfermedad reumática y su tratamiento, características clínicas, laboratorio, complicaciones y tratamientos de la infección por SARS-CoV-2. Resultados: se incluyeron 525 pacientes, con una edad media de 51.3 años (DE 15.2). Las enfermedades reumatológicas más frecuentes fueron artritis reumatoidea (40.4%), lupus eritematoso sistémico (14.9%) y espondiloartritis (8.2%). El 72.9% recibía tratamiento inmunosupresor o inmunomodulador al momento del inicio de la infección y 36.9% glucocorticoides. En la mayoría de los casos, el diagnóstico de infección por SARS-CoV-2 se llevó a cabo mediante RT-PCR (95%), 39.4% en la consulta externa, 32.2% en el departamento de urgencias, y 14.7% durante la hospitalización. La mayoría de los pacientes presentaron síntomas, siendo los más frecuentes fiebre (56.2%), tos (46.7%) y cefalea (39.2%). Durante la infección, 35.1% requirieron hospitalización y 11.6% en unidad de cuidados intensivos. El 75.1% se recuperó completamente, 8.4% presentó secuelas y 6.9% murieron a causa de COVID-19. Conclusión: en este primer reporte del registro SAR-COVID encontramos una amplia distribución de enfermedades reumáticas. La mayoría de los pacientes tuvieron una buena evolución de la infección, sin embargo un 7% falleció como consecuencia de la misma, datos comparables a los reportados por otros registros latinoamericanos con poblaciones similares

Resistance to mesenchymal reprogramming sustains clonal propagation in metastatic breast cancer

The acquisition of mesenchymal traits is considered a hallmark of breast cancer progression. However, the functional relevance of epithelial-to-mesenchymal transition (EMT) remains controversial and context dependent. Here, we isolate epithelial and mesenchymal populations from human breast cancer metastatic biopsies and assess their functional potential in vivo. Strikingly, progressively decreasing epithelial cell adhesion molecule (EPCAM) levels correlate with declining disease propagation. Mechanistically, we find that persistent EPCAM expression marks epithelial clones that resist EMT induction and propagate competitively. In contrast, loss of EPCAM defines clones arrested in a mesenchymal state, with concomitant suppression of tumorigenicity and metastatic potential. This dichotomy results from distinct clonal trajectories impacting global epigenetic programs that are determined by the interplay between human ZEB1 and its target GRHL2. Collectively, our results indicate that susceptibility to irreversible EMT restrains clonal propagation, whereas resistance to mesenchymal reprogramming sustains disease spread in multiple models of human metastatic breast cancer, including patient-derived cells in vivo