Chronic wounds and advanced therapies, compatible in primary care?

RESUMEN: El envejecimiento progresivo de la población ha aumentado el riesgo de padecer enfermedades crónicas como patologías vasculares de extremidades inferiores. La aparición de úlceras vasculares arteriales, venosas y de pie diabético son complicaciones de gran morbilidad y mortalidad. Los cambios fisiológicos que padecen las personas mayores y la inmovilidad, son factores de riesgo que favorecen otras como las úlceras por presión. Su cronificación es la consecuencia de la prolongación de la fase inflamatoria. La cicatrización es un proceso endógeno que depende del paciente, el tipo de lesión y el tratamiento escogido. La curación supone un verdadero reto para el personal de enfermería de Atención Primaria de Salud y altos costes económicos. Las terapias avanzadas para el manejo de heridas crónicas están basadas en evidencias científicas que demuestran elevadas tasas de curación, reducción del tamaño de la lesión y mejora en la calidad de vida. Se deben establecer protocolos que disminuyan la variabilidad en la práctica enfermera y fomentar la investigación para poder introducirlas. Es importante que la Atención Primaria de Salud disponga de conocimientos y productos de cura convencional y avanzada, que permitan un tratamiento único, ya que ofrece los cuidados más continuados y evita las derivaciones innecesarias a especialistas.ABSTRACT: The progressive aging of the population has increased the risk of suffering chronic diseases such as vascular diseases of the lower extremities. The appearance of vascular arterial ulcers, venous ulcers and diabetic foot are complications of great morbidity and mortality. Physiological changes in the elderly and immobility, are risk factors that favor others such as pressure ulcers. Its chronification is the consequence of the prolongation of the inflammatory phase. The healing is an endogenous process that depends on the patient, the type of wound and the treatment chosen. The curation of the wound is a real challenge for nurses of Primary Health Care and means high economic costs. Advanced therapies for the management of chronic wounds are based on scientific evidence that proves high rates of healing, reduction of the size of the wound and better quality of life. Protocols should be established due to the reduction of the variability in nursing practice and encourage research to be able to introduce them. It is important that Primary Health Care have knowledge of conventional and advanced healing products, which allow a unique treatment. It provides the most continuous care and avoids unnecessary referrals to specialists.Grado en Enfermerí

The Meaning of Self-Identity Search and Self-Disclosure Experience of Non-Binary People in Indonesia

Gender adalah sebuah spektrum yang mengalami perkembangan dengan sangat pesat. Konstruksi gender telah diterapkan oleh masyarakat secara turun temurun. Terdapat kemungkinan terjadinya dekonstruksi gender dalam masyarakat yang bersifat oposisi dan kontradiktif. Terdapat sekelompok individu yang mengidentifikasi diri mereka diluar dari laki-laki dan perempuan atau biasa disebut sebagai non-binary. Tujuan dari penelitian ini adalah untuk meninjau pengalaman individu non-binary dalam proses pencarian identitas gender, proses penerimaan diri, dan proses interaksi dengan masyarakat. Metode yang digunakan dalam penelitian ini adalah fenomenologi Husserl atau transendental yang bertujuan untuk mengungkap pengalaman dari individu non-binary. Data diperoleh melalui wawancara mendalam dengan tiga individu non-binary yang memiliki identitas gender berbeda-beda, yaitu genderfluid, agender, dan genderqueer. Hasil dari penelitian menunjukkan bahwa individu non-binary merasakan ketidakjelasan terhadap identitas gender mereka sejak kecil. Mereka kerap merasa tidak sesuai dengan konstruksi yang berlaku di masyarakat. Setelah melakukan riset dan menjalin hubungan dengan beberapa orang, mereka mulai mengenal istilah non-binary dan merasa bahwa istilah tersebut cocok untuk diri mereka. Pengalaman mereka berlanjut ketika harus berinteraksi dengan orang sekitar. Individu non-binary memiliki kecenderungan enggan untuk memberitahu keluarga tentang identitas gender mereka. Namun, mereka merasa nyaman ketika melakukan pengungkapan diri kepada teman-teman sekitar. Ketiga individu non- binary memutuskan untuk menghiraukan jika ada opini negatif tentang mereka. Pada akhirnya, hal yang paling penting adalah mereka merasa nyaman dengan diri mereka sendiri

Aktivitas Direct Marketing GoPayLater pada Gojek Financial Services Platform

Layanan fintech di Indonesia telah menjadi tren yang terus berkembang sehingga dapat menjadi industri yang prospektif. Perusahaan berbasis digital yang menyediakan layanan fintech dianggap mampu membawa dampak bagi stabilitas moneter Negara. Salah satu perusahaan yang menyediakan layanan fintech adalah Gojek Financial Services Platform dengan berbagai macam layanan finansial yang siap membantu parapenggunanya. Produk-produk yang ditawarkan oleh Gojek Financial Services Platform telah melekat dalam kehidupan masyarakat sehari- hari karena sifatnya yang praktis dan mudah digunakan. Salah satu produk yang ditawarkan adalah GoPayLater dimana layanan tersebut menyediakan metode pembayaran pascabayar untuk segala macam transaksi di dalam aplikasi Gojek, online merchant, dan transaksi di Tokopedia. Dalam memasarkan produknya, GoPayLater menerapkan strategi pemasaran direct marketing dengan tujuan untuk mengakuisisi pengguna baruserta mempertahankan pengguna lama agar tetap menggunakan produk mereka. Pada praktik kerja magang ini, penulis berperan sebagai Product Marketing Intern yang bertanggungjawab untuk membantu pelaksanaan aktivitas direct marketing yang dilakukan oleh produk GoPayLater. Penulis turut andil dalam mengeksekusi beberapa channel yang dipilih oleh GoPayLater sebagai sarana aktivitas pemasaran. Melalui proses praktik kerja magang ini, penulis mendapatkan banyak sekali pembelajaran baru serta pemahaman secara mendalam mengenai direct marketing suatu campaign, mulai dari perencanaan hingga analisis evaluasi performa campaign. Selain itu, penulis juga memberikan saran bagi Universitas Multimedia Nusantara untuk memperdalam kembali materi pada mata kuliah Direct Marketing & Customer Relationship Management secara digital. Penulis juga memberikan saran untuk Gojek Financial Services Platform berkaitan dengan pembentukan satu unit sinergi antara beberapa stakeholder dan pembuatan suatu dokumen yang berisi guideline tentang perencanaan aktivitas pemasaran

Exploring the IL-21–STAT3 Axis as Therapeutic Target for Sézary Syndrome

Sézary syndrome is an aggressive cutaneous T-cell lymphoma. The malignant cells (Sézary cells) are present in skin, lymph nodes, and blood, and express constitutively activated signal transducer and activator of transcription (STAT)3. STAT3 can be activated by IL-21 in vitro and the IL-21 gene itself is a STAT3 target gene, thereby creating an autocrine positive feedback loop that might serve as a therapeutic target. Sézary cells underwent apoptosis when incubated with Stattic, a selective STAT3 inhibitor. STAT3 activation in Sézary cells did not affect expression of the supposed anti-apoptotic STAT3 target genes BCL2, BCL-xL, and SURVIVIN, whereas expression of (proto)oncogenes miR-21, TWIST1, MYC, and PIM1 was significantly increased. CD3/CD28-mediated activation of Sézary cells induced IL-21 expression, accompanied by STAT3 activation and increased proliferation. Blocking IL-21 in CD3/CD28-activated cells had no effects, whereas Stattic abrogated IL-21 expression and cell proliferation. Thus, specific inhibition of STAT3 is highly efficient in the induction of apoptosis of Sézary cells, likely mediated via the regulation of (proto)oncogenes. In contrast, blocking IL-21 alone seems insufficient to affect STAT3 activation, cell proliferation, or apoptosis. These data provide further insights into the pathogenic role of STAT3 in Sézary syndrome and strengthen the notion that STAT3 represents a promising therapeutic target in this disease

A dominant repressor version of the tomatoSl-ERF.B3gene confers ethylene hypersensitivity via feedback regulation of ethylene signaling and response components

Ethylene Response Factors (ERFs) are downstream components of the ethylene signal transduction pathway, although their role in ethylene-dependent developmental processes remains poorly understood. As the ethylene-inducible tomato Sl-ERF.B3 has been shown previously to display a strong binding affinity to GCC-box-containing promoters, its physiological significance was addressed here by a reverse genetics approach. However, classical up- and down-regulation strategies failed to give clear clues to its roles in planta, probably due to functional redundancy among ERF family members. Expression of a dominant repressor ERF.B3-SRDX version of Sl-ERF.B3 in the tomato resulted in pleiotropic ethylene responses and vegetative and reproductive growth phenotypes. The dominant repressor etiolated seedlings displayed partial constitutive ethylene response in the absence of ethylene and adult plants exhibited typical ethylene-related alterations such as leaf epinasty, premature flower senescence and accelerated fruit abscission. The multiple symptoms related to enhanced ethylene sensitivity correlated with the altered expression of ethylene biosynthesis and signaling genes and suggested the involvement of Sl-ERF.B3 in a feedback mechanism that regulates components of ethylene production and response. Moreover, Sl-ERF.B3 was shown to modulate the transcription of a set of ERFs and revealed the existence of a complex network interconnecting different ERF genes. Overall, the study indicated that Sl-ERF.B3 had a critical role in the regulation of multiple genes and identified a number of ERFs among its primary targets, consistent with the pleiotropic phenotypes displayed by the dominant repression lines

Development of postural adjustments during reaching in typically developing infants from 4 to 18 months

Knowledge on the development of postural adjustments during infancy, in particular on the development of postural muscle coordination, is limited. This study aimed at the evaluation of the development of postural control during reaching in a supported sitting condition. Eleven typically developing infants participated in the study and were assessed at the ages of 4, 6, 10 and 18 months. We elicited reaching movements by presenting small toys at an arm’s length distance, whilst activity of multiple arm, neck and trunk muscles was recorded using surface EMG. A model-based computer algorithm was used to detect the onset of phasic muscle activity. The results indicated that postural muscle activity during reaching whilst sitting supported is highly variable. Direction-specific postural activity was inconsistently present from early age onwards and increased between 10 and 18 months without reaching a 100 % consistency. The dominant pattern of activation at all ages was the ‘complete pattern’, in which all direction-specific muscles were recruited. At 4 months, a slight preference for top-down recruitment existed, which was gradually replaced by a preference for bottom-up recruitment. We conclude that postural control during the ecological task of reaching during supported sitting between 4 and 18 months of age is primarily characterized by variation. Already from 4 months onwards, infants are—within the variation—sometimes able to select muscle recruitment strategies that are optimal to the task at hand

Staphylococcal enterotoxin A (SEA) stimulates STAT3 activation and IL-17 expression in cutaneous T-cell lymphoma

Cutaneous T-cell lymphoma (CTCL) is characterized by proliferation of malignant T cells in a chronic inflammatory environment. With disease progression, bacteria colonize the compromised skin barrier and half of CTCL patients die of infection rather than from direct organ involvement by the malignancy. Clinical data indicate that bacteria play a direct role in disease progression, but little is known about the mechanisms involved. Here, we demonstrate that bacterial isolates containing staphylococcal enterotoxin A (SEA) from the affected skin of CTCL patients, as well as recombinant SEA, stimulate activation of signal transducer and activator of transcription 3 (STAT3) and upregulation of interleukin (IL)-17 in immortalized and primary patient-derived malignant and nonmalignant T cells. Importantly, SEA induces STAT3 activation and IL-17 expression in malignant T cells when cocultured with nonmalignant T cells, indicating an indirect mode of action. In accordance, malignant T cells expressing an SEA-nonresponsive T-cell receptor variable region β chain are nonresponsive to SEA in monoculture but display strong STAT3 activation and IL-17 expression in cocultures with SEA-responsive nonmalignant T cells. The response is induced via IL-2 receptor common γ chain cytokines and a Janus kinase 3 (JAK3)-dependent pathway in malignant T cells, and blocked by tofacitinib, a clinical-grade JAK3 inhibitor. In conclusion, we demonstrate that SEA induces cell cross talk-dependent activation of STAT3 and expression of IL-17 in malignant T cells, suggesting a mechanism whereby SEA-producing bacteria promote activation of an established oncogenic pathway previously implicated in carcinogenesis

UC-1V150, a potent TLR7 agonist capable of activating macrophages and potentiating mAb-mediated target cell deletion

Toll‐like receptors (TLR) are critical mediators of the immune system with their activation linked to infection, inflammation and the pathogenesis of immune diseases including autoimmunity and cancer. For this reason, over the last 2 decades, TLR and their associated signalling pathways have been targeted therapeutically to enhance innate and adaptive immunity. Several TLR ligands, both endogenous and synthetic are at various phases of clinical testing, and new ligands are continually emerging. Agonists of TLR7 are known immune response modifiers, simultaneously stimulating several cell types, resulting in immune cell activation and cytokine and chemokine release. The immune stimulating properties of the TLR7 agonist Imiquimod has also been exploited for use in the treatment of malignant superficial tumours of the skin. Here, we investigated a novel TLR7 agonist UC‐1V150 and demonstrate it activates both human and mouse myeloid cells in vitro and in vivo, to deliver potent FcγR‐mediated engulfment of opsonized target cells