[Prevalence of frailty in a population aged 70 and older who pay a visit to health center and its detection in primary care]. / Prevalencia de fragilidad en personas de 70 o más años que acuden a un centro de salud y su detección en atención primaria.

INTRODUCTION: The detection of frailty in the elderly is key to preventing disability. The main objective of this study is to find out the proportion of frail people in subjects aged 70 and over who attend a health center in A Coruña (Spain). METHODS: Cross-sectional study, carried out from August 2020 to April 2021. Consecutive selection of patients ≥70 years, with Barthel ≥90, who accessed the health center. DEPENDENT VARIABLES: Short Physical Performance Battery (SPPB), Get Up and Go (TUG) and Gait Speed (MV); independent: gender, age, number of falls in the last year, number of drugs used chronically, and Charlson index. RESULTS: The sample was 114 people. The proportion of frail people is 16.7% (95% CI 10.94-24.57) with the SPPB, 28.6% in those aged 80 and over; and 36.8% using VM. The risk of frailty increases by at least 4.1% for each year of age after 70. Being a woman multiplies the risk by at least 1.5. The concordance between frailty according to the SPPB and MV is 46.8% (95% CI 30.85-62.77). CONCLUSIONS: The prevalence of frailty in independent people for basic ADL who attend a health center is at least 10.94%. Both the SPPB and the MV are feasible and useful methods in primary care.

Preclinical and Clinical Trials of New Treatment Strategies Targeting Cancer Stem Cells in Subtypes of Breast Cancer.

Breast cancer (BC) can be classified into various histological subtypes, each associated with different prognoses and treatment options, including surgery, radiation, chemotherapy, and endocrine therapy. Despite advances in this area, many patients still face treatment failure, the risk of metastasis, and disease recurrence, which can ultimately lead to death. Mammary tumors, like other solid tumors, contain a population of small cells known as cancer stem-like cells (CSCs) that have high tumorigenic potential and are involved in cancer initiation, progression, metastasis, tumor recurrence, and resistance to therapy. Therefore, designing therapies specifically targeting at CSCs could help to control the growth of this cell population, leading to increased survival rates for BC patients. In this review, we discuss the characteristics of CSCs, their surface biomarkers, and the active signaling pathways associated with the acquisition of stemness in BC. We also cover preclinical and clinical studies that focus on evaluating new therapy systems targeted at CSCs in BC through various combinations of treatments, targeted delivery systems, and potential new drugs that inhibit the properties that allow these cells to survive and proliferate.

Construção e validação de Quiz para avaliação de conhecimento cognitivo sobre febre maculosa / Creation and validation of a quiz to assess cognitive knowledge about spotted fever / Construcción y validación de un cuestionario para evaluar los conocimientos cognitivos sobre la fiebre maculosa

Objetivo: construir e validar um Quiz de avaliação cognitiva sobre Febre Maculosa, voltado para avaliar o conhecimento de estudantes que moram e/ou frequentam cidades de risco para a doença. Métodos: estudo metodológico desenvolvido em três etapas: construção do Quiz; validação de aparência e conteúdo com nove juízes, com análise realizada através do cálculo de Índice de Validade de Conteúdo, com valor de corte 0,80; e validação semântica, seguindo a metodologia DISABKIDS® com 12 alunos de cursos técnicos profissionalizantes, com avaliação dos dados realizada por estatística descritiva, tendo sido utilizado o programa Statistical Package for the Social Sciences. Resultados: o processo de validação foi subdividido em duas etapas: validação de aparência e conteúdo por profissionais das áreas de biologia e educação e validação semântica por alunos de cursos profissionalizantes. O Quiz foi elaborado e aplicado e os resultados mostraram um índice de validade de conteúdo superior a 0,80 para todas as variáveis analisadas. Na validação semântica, o Quiz foi considerado como de fácil compreensão e não houve dificuldade para o preenchimento. Conclusão: o Quiz construído foi validado quanto à aparência, ao conteúdo e à semântica, tendo alcançado concordância satisfatória, o que garante ser um instrumento adequado para o processo de avaliação sobre a temática investigada. Com isso, espera-se contribuir para a difusão de conhecimento acerca da identificação dos fatores de risco e da prevenção da saúde relacionados à Febre Maculosa.(AU)

Objective: to create and validate a cognitive assessment Quiz about Spotted Fever, targeted at evaluating what students living in and/or traveling to risk cities know about the disease. Methods: a methodological study developed in three stages: creation of the Quiz; face and content validation with nine judges, with analysis performed by calculating the Content Validity Index, with a cutoff value of 0.80; and semantic validation, following the DISABKIDS®methodology with 12 students from professional technical courses, with data evaluation performed by means of descriptive statistics, using the Statistical Package for the Social Sciences program. Results: the validation process was subdivided into two stages: face and content validation by professionals in the Biology and Education areas, and semantic validation by students attending professional courses. The Quiz was prepared and applied and the results showed a Content Validity Index above 0.80 for all the variables analyzed. In the semantic validation, the Quiz was considered as easy to understand and there were no difficulties filling it in. Conclusion: the Quiz created was validated in terms of face, content and semantics, having achieved satisfactory agreement, which guarantees that it is an adequate instrument for the evaluation process on the theme investigated. With this, the expectation is to contribute to disseminating knowledge about the identification of risk and health prevention factors related to Spotted fever.(AU)

Objetivo: construir y validar un Cuestionario de evaluación cognitiva sobre la Fiebre Maculo-sa, destinado a evaluar los conocimientos de los estudiantes que viven y/o asisten a ciudades con riesgo para la enfermedad. Métodos: estudio metodológico desarrollado en tres etapas: construcción del Cuestionario; validación de apariencia y contenido con nueve jueces con aná-lisis realizado mediante el cálculo del Índice de Validez de Contenido, con un valor de corte de 0.80 y validación semántica, siguiendo la metodología DISABKIDS® con 12 estudiantes de carreras técnicas profesionales, con evaluación de datos realizada mediante estadística des-criptiva, donde se utilizó el programa Statistical Package for the Social Sciences. Resultados: el proceso de validación se subdividió en dos etapas: validación de apariencia y contenido por profesionales de las áreas de biología y educación, y validación semántica por estudiantes de carreras profesionales. El Cuestionario fue diseñado y aplicado. Los resultados mostraron un índice de validez de contenido superior a 0,8 para todas las variables analizadas...(AU)

In Vivo and in vitro antitumor activity of tomatine in hepatocellular carcinoma.

Background: There is abundant ethnopharmacological evidence the uses of regarding Solanum species as antitumor and anticancer agents. Glycoalkaloids are among the molecules with antiproliferative activity reported in these species. Purpose: To evaluate the anticancer effect of the Solanum glycoalkaloid tomatine in hepatocellular carcinoma (HCC) in vitro (HepG2 cells) and in vivo models. Methods: The resazurin reduction assay was performed to detect the effect of tomatine on cell viability in human HepG2 cell lines. Programmed cell death was investigated by means of cellular apoptosis assays using Annexin V. The expression of cancer related proteins was detected by Western blotting (WB). Reactive oxygen species (ROS) and calcium were determined by 2,7-dichlorodihydrofluorescein diacetate and Fluo-4, respectively. Intrahepatic HepG2 xenograft mouse model was used to elucidate the effect of tomatine on tumor growth in vivo. Results and Discussion: Tomatine reduced HepG2 cell viability and induced the early apoptosis phase of cell death, consistently with caspase-3, -7, Bcl-2 family, and P53 proteins activation. Furthermore, tomatine increased intracellular ROS and cytosolic Ca+2 levels. Moreover, the NSG mouse xenograft model showed that treating mice with tomatine inhibited HepG2 tumor growth. Conclusion: Tomatine inhibits in vitro and in vivo HCC tumorigenesis in part via modulation of p53, Ca+2, and ROS signalling. Thus, the results suggest the potential cancer therapeutic use of tomatine in HCC patients.

Mídias sociais digitais no acesso a informações de saúde baseadas em evidências / Digital social media in accessing evidence-based health information / Redes sociales digitales en el acceso a información de salud basada en evidencia

Objetivo: analisar o acesso a informações de saúde baseadas em evidências em linguagem fácil por meio de mídias sociais digitais junto a profissionais atuantes na Estratégia Saúde da Família antes e após atividade educativa. Método: estudo quase-experimental, do tipo antes e depois, em que se analisaram as mudanças relativas à busca e ao acesso a informações de saúde baseadas em evidência por profissionais da Estratégia Saúde da Família que participaram de atividade educativa. Na análise dos dados, utilizou-se a versão generalizada do teste qui-quadrado de McNemar. Resultados: os resultados evidenciaram que 50% dos participantes passaram a buscar informações de saúde baseadas em evidências (p=0,016) após a participação na atividade educativa, com maior utilização da internet para a busca dessas informações (p=0,008). Conclusão: o desenvolvimento de atividade educativa estimulou e facilitou o acesso a informações de saúde nas mídias digitais baseadas em evidências, em linguagem fácil, contribuindo para aumentar a busca por informações qualificadas e aplicáveis no trabalho dos profissionais da Estratégia de Saúde da Família.(AU)

Objective: to analyze the access to evidence-based health information in easy language through digital social media with professionals working in the Family Health Strategy before and after educational activity. Method: quasi-experimental study of the type before and after, in which the changes related to the search for and access to evidence-based health information by professionals from the Family Health Strategy who participated in educational activities were analyzed. In the data analysis, the generalized version of the McNemar chi-square test was used. Results: The results showed that 50% of the participants started to search for evidencebased health information (p = 0.016) after participating in the educational activity, with greater use of the internet to search for this information (p = 0.008). Conclusion: The development of educational activity stimulated and facilitated access to health information in digital media based on evidence, in easy language, contributing to increase the search for qualified and applicable information in the work of the professionals of the Family Health Strategy.(AU)

Objetivo: analizar el acceso a información de salud basada en evidencias en lenguaje fácil a través de las redes sociales digitales con profesionales que trabajan en la Estrategia Salud de la Familia antes y después de la actividad educativa. Método: estudio cuasiexperimental del tipo antes y después, en el que se analizaron los cambios relacionados con la búsqueda y acceso a información en salud basada en evidencia por parte de los profesionales de la Estrategia Salud de la Familia que participaron en actividades educativas. En el análisis de los datos se utilizó la versión generalizada de la prueba chi-cuadrado de McNemar. Resultados: Los resultados mostraron que el 50% de los participantes comenzaron a buscar información de salud basada en evidencia (p = 0.016) luego de participar en la actividad educativa, con mayor uso de internet para buscar esta información (p = 0.008). Conclusión: El desarrollo de la actividad educativa estimuló y facilitó el acceso a la información en salud en medios digitales basados en evidencia, en lenguaje fácil, contribuyendo a incrementar la búsqueda de información calificada y aplicable en el trabajo de los profesionales de la Estrategia Salud de la Familia.(AU)

Early recognition of surgical patients with sepsis: Contribution of nursing records.

OBJECTIVE: This study aimed to analyze the contribution of nursing records to the early identification and management of sepsis in surgical patients at a university hospital. METHOD: This is a study with a quantitative, retrospective, descriptive, and correlational design. Data collection was performed through hospital information systems in the first semester of 2017 with the approval of the research ethics committee. We included 28 patients who met the inclusion criteria of the study. RESULTS: The analysis of the content of the records evidenced the development of the first signs of systemic inflammatory response syndrome (SIRS) and organ dysfunction until the fifth day of hospitalization in 19 patients (67.8%). Confirmation or hypothesis of sepsis diagnosis occurred until the 10th day of hospitalization in 15 patients (53.5%). The analysis of the content of the records showed that the first signs of SIRS were predominantly identified in the electronic patient monitoring system in 26 cases (92.9%), whereas the first signs of organ dysfunction were described in the nursing staff records in 24 patients (85.7%). CONCLUSION: The results confirm the importance of the quality of nursing records for risk identification, early recognition, and proper management of sepsis in surgical patients, aiming at achieving greater effectiveness in the management of healthcare processes.

Desenvolvimento de protótipo de tecnologia digital gamificada para apoio aos profissionais de enfermagem frente ao estresse ocupacional: proposta de intervenção / Development of a gamified application prototype to support nursing professionals in the face of occupational stress: intervention proposal

A gamificação é a utilização dos mesmos contextos utilizados em jogos de videogame para elaboração do conteúdo de interesse, levando em consideração a dinâmica e a mecânica. A gamificação é considerada uma maneira eficaz para realizar uma intervenção, ao favorecer a aproximação da população estudada, despertar maior interesse pelo tema que está sendo discutido e desencadear uma resposta positiva para alcance do objetivo proposto. As tecnologias virtuais e aplicativos podem ser tão eficientes ou até mesmo mais eficientes do que a terapia convencional para o tratamento do Estresse Ocupacional, de acordo com evidências da literatura. O objetivo deste trabalho foi desenvolver e avaliar protótipo de tecnologia digital gamificada para abordagem de conteúdos relacionados à prevenção e identificação de estresse ocupacional junto aos profissionais da equipe de enfermagem. Trata-se de pesquisa aplicada, de produção tecnológica, exploratória e descritiva, que terá como resultado a criação de uma tecnologia digital gamificada. Serão realizadas quatro etapas específicas para responder aos objetivos propostos do estudo: Etapa I - Mapeamento de fatores estressores relacionados à atuação profissional em enfermagem descrita na literatura; Etapa II - Revisão Integrativa da Literatura para fundamentar a intervenção; Etapa III - Elaboração da tecnologia digital gamificada; Etapa IV - Julgamento por profissionais especializados em gamificação e estresse ocupacional. A usabilidade e o conteúdo do protótipo de média fidelidade da tecnologia digital gamificada foram avaliados segundo as heurísticas de Nielsen e as taxonomias de Bloom. A tecnologia digital gamificada tem enfoque na prevenção de possíveis agravos do estresse ocupacional e evolução para a síndrome de Burnout,baseada na utilização de roda de conversa e chat moderado on-line que permita que os usuários troquem vivências e realize uma discussão acerca do que for proposto pelos moderadores.O protótipo de tecnologia digital gamificada foiavaliada por sete especialistas da área, de informática, informática em enfermagem e enfermagem especializada em estresse ocupacional, sendo avaliado a usabilidade e os conteúdos utilizados na tecnologia. Todos os sete especialistas (100%) reconheceram a relevância do uso de tecnologias digitais gamificadas para abordagem do Estresse Ocupacional e Síndrome de Burnout. A avaliação do conteúdo relacionado à lembrança das informações relacionadas ao tema e potencial para possibilitar compreensão receberam sete (100%) das respostas como "Sim", possíveis de serem alcançadas. Em relação ao potencial para favorecer a aplicação do conteúdo, 06 (86%) responderam "Sim" e 01 (14%) respondeu em partes possíveis de serem alcançadas. As possíveis respostas que poderiam ser dadas pelos avaliadores eram: "Sim", "Não" e "Em partes". A Heurística que abordava sobre Estética e design minimalista foi apontada por 03 (43%) que apontaram que não é considerada, totalmente, um problema de usabilidade, 02 (28,5%) considerou como um problema apenas estético e que não necessita ser consertada a menos que haja tempo disponível e 02 (28,5%) a entenderam como um problema menor de usabilidade: o conserto desse problema deverá ter baixa prioridade. O protótipo foi considerado como uma estratégia possivelmente interessante e eficaz para abordagem de conteúdos relacionados ao proposto pela pesquisa porque utiliza de uma abordagem fácil, interativa e de apoio mútuo entre os usuários. Por fim, esse trabalho mostra a relevância de uma tecnologia digital gamificada para a saúde e enfermagem, tendo sido elaborado em um momento crítico vivenciado pela população mundial devido à pandemia pelo Novo Coronavírus. A utilização de um chat moderado para aplicação da técnica de roda de conversa é o diferencial desse protótipo, atuando no apoio social, contribuindo para a diminuição dos níveis do estresse ocupacional. A utilização da roda de conversa por meio de um chat moderado on-line é uma abordagem promissora que pode gerar frutos positivos em momentos de distanciamento social que os encontros presenciais não são recomendados. O fato do protótipo não ter sido testado pelo público alvo também pode ser um fator limitante por não permitir conhecer as reais necessidades que devem ser abordadas para aqueles que realmente farão uso da tecnologia digital gamificada. A aplicação da roda de conversa por meio de um chat moderado pode ser um fator limitante se os moderadores responsáveis por direcionar as discussões no chat on-line não tiver destreza e habilidades suficientes para manejar situações conflituosas no momento de abordagem de determinados assuntos que estejam em discussão. Ainda são necessários novos estudos para avaliar a real eficácia do uso de tecnologias digitais gamificadas para a saúde dos profissioanais da equipe de enfermagem

Gamification is considered an effective way to carry out an intervention, by favoring the approach of the studied population, arousing greater interest in the topic being discussed and triggering a positive response to achieve the proposed objective. Virtual technologies and applications can be just as efficient or even more efficient than conventional therapy for the treatment of Occupational Stress and Burnout Syndrome, according to evidence in the literature. The objective of this work was to develop and evaluate a gamified application prototype for approaching content related to the prevention and identification of occupational stress and Burnout syndrome with the professionals of the nursing team. This is applied research, technological, exploratory and descriptive production, which will result in the creation of a gamified application. Four specific steps will be taken to answer the proposed objectives of the study: Step I - Mapping of stressors related to the professional performance in nursing described in the literature; Stage II - Integrative Literature Review to support the intervention; Stage III - Elaboration of the tool; Stage IV - Judgment by professionals specialized in gamification and occupational stress / Syndrome Burnout. A prototype of gamified digital technology with an emphasis on design was developed. The prototype and the content of the technology were evaluated by seven experts in the field, being pointed out as an interesting and effective strategy for approaching content related to that proposed by the research because it uses an easy, interactive and mutually supportive approach between users. Finally, this work shows the relevance of a gamified digital technology for health and nursing, having been elaborated at a critical moment experienced by the world population due to the pandemic by the New Coronavirus. The use of a moderate chat to apply the conversation wheel technique is the differential of this prototype, acting in social support, contributing to the reduction of occupational stress levels. Further studies are still needed to assess the real effectiveness of using gamified digital technologies for the health of the nursing team's professionals

Ideação suicida e tentativa de suicídio entre pessoas em tratamento psiquiátrico / Suicidal ideation and suicide attempt among people in psychiatric treatment / Ideación suicida e intento de suicidio entre personas en tratamiento psiquiátrico

Este estudo investigou a relação entre ideação suicida, tentativa de suicídio e características psicossociais e psiquiátricas de pacientes com transtornos psiquiátricos. Realizado estudo quantitativo por meio da análise documental de prontuários de um centro de atenção psicossocial de uma cidade do interior do Sudeste do Brasil. Entre os 410 prontuários analisados, foi encontrado 24,4% com registro de ideação suicida e 22,9% com tentativa de suicídio. Entre os pacientes com ideação suicida e tentativa de suicídio, verifica-se que a maioria são homens, adultos, sem vínculo matrimonial, com baixa escolaridade, inatividade laboral e apresentam os transtornos do humor como diagnóstico principal e comorbidade psiquiátrica de maior frequência. Identificou-se associação de ideação suicida e tentativa de suicídio com comorbidade psiquiátrica e tentativa de suicídio com história de experiência traumática. Importante realizar avaliação do risco dos pacientes com história de comportamento suicida para melhor manejo e prevenção do suicídio.

This study investigated the relationship between suicidal ideation, suicide attempt and psychosocial and psychiatric characteristics of patients with psychiatric disorders. A quantitative study was carried out based on the documentary analysis of records at a psychosocial care center of a town in the southeast of Brazil. Among the 410 medical records analyzed, 24.4% were found to have suicidal ideation and 22.9% referred to suicide attempts. Among the patients with suicidal ideation and suicide attempt, it is verified that the majority are men, adults, without marital bond, with low educational level, work inactivity, and present mood disorders as the main diagnosis and psychiatric comorbidity of higher frequency. It was identified association of suicidal ideation and suicide attempt with psychiatric comorbidity and suicide attempt with history of traumatic experience. Important perform risk assessment of patients with a history of suicidal behavior to better management and suicide prevention.

Este estudio investigó la relación entre ideación suicida, intento de suicidio y las características psicosociales y psiquiátricas de los pacientes con trastornos psiquiátricos. Estudio cuantitativo realizado por análisis documental de los expedientes de un centro de atención psicosocial de una ciudad en el sureste de Brasil. Entre los 410 registros de pacientes analizados se encontró 24,4% con registro de ideación suicida y 22,9% con intento de suicidio. Entre los pacientes con ideación suicida e intento de suicidio, se encontró que la mayoría son hombres, adultos, sin vínculo matrimonial, con bajo nivel de educación, inactividad laboral, y tienen los trastornos del ánimo como el diagnóstico primario y comorbilidad psiquiátrica más frecuente. Se identificó asociación de ideación suicida e intento de suicidio con comorbilidad psiquiátrica e intento de suicidio con historia de experiencia traumática. Importante realizar la evaluación del riesgo de los pacientes con antecedentes de comportamiento suicida para una mejor gestión y prevención del suicidio.

Vulnerabilidades da população em situação de rua ao comportamento suicida / Vulnerabilities of the homeless population to suicide behavior

Objetivo: compreender as vulnerabilidades de adultos em situação de rua ao comportamento suicida. Método: trata-se de um estudo qualitativo, descritivo, realizado com oito pessoas em situação de rua com história de tentativa de suicídio. Fez-se a coleta de dados por meio de entrevista, e os resultados a partir da técnica de Análise de Conteúdo na modalidade Análise Categorial. Resultados: entende-se que as categorias geradas a partir da análise temática dos dados foram os contextos de vulnerabilidade à ideação suicida, tentativa de suicídio e suicídio para pessoas em situação de rua. Observou-se que os entrevistados acreditam que o comportamento suicida ocorre na população em situação de rua em função da tristeza, sofrimento, desesperança, uso problemático de álcool e/ou outras drogas, doenças e falta de fé. Conclusão: expõem-se os adultos em situação de rua a constantes e diversas situações de vulnerabilidades ao comportamento suicida.(AU)

Objective: to understand the vulnerabilities of street adults to suicidal behavior. Method: this is a qualitative, descriptive study carried out with eight street persons with a history of attempted suicide. Data was collected through an interview, and the results were obtained from the Content Analysis technique in the Categorical Analysis modality. Results: it is understood that the categories generated from the thematic analysis of the data were contexts of vulnerability to suicidal ideation, suicide attempt and suicide for street people. It was observed that the interviewees believe that suicidal behavior occurs in the street population due to sadness, suffering, and hopelessness, problematic use of alcohol and / or other drugs, illness and lack of faith. Conclusion: the adults in the street situation are exposed to constant and diverse situations of vulnerability to suicidal behavior.(AU)

Objetivo: comprender las vulnerabilidades de los adultos en situación de calle al comportamiento suicida. Método: se trata de un estudio cualitativo, descriptivo, realizado con ocho personas en situación de calle con historia de intento de suicidio. Se hizo la recolección de datos por medio de entrevista, y los resultados a partir de la técnica de Análisis de Contenido en la modalidad Análisis Categorial. Resultados: se entiende que las categorías generadas a partir del análisis temático de los datos fueron los contextos de vulnerabilidad a la ideación suicida, intento de suicidio y suicidio para personas en situación de calle. Se observó que los entrevistados creen que el comportamiento suicida ocurre en la población en situación de calle en función de la tristeza, sufrimiento, desesperanza, uso problemático de alcohol y / u otras drogas, enfermedades y falta de fe. Conclusión: se exponen los adultos en situación de calle a constantes y diversas situaciones de vulnerabilidades al comportamiento suicida.(AU)

Skewed Signaling through the Receptor for Advanced Glycation End-Products Alters the Proinflammatory Profile of Tumor-Associated Macrophages.

Tumors are complex tissues composed of variable amounts of both non-cellular components (matrix proteins) and a multitude of stromal cell types, which are under an active cross-talk with tumor cells. Tumor-associated macrophages (TAMs) are the major leukocyte population among the tumor-infiltrating immune cells. Once they are infiltrated into tumor stroma they undergo a polarized activation, where the M1 and M2 phenotypes represent the two extreme of the polarization heterogeneity spectrum. It is known that TAMs acquire a specific phenotype (M2), oriented toward tumor growth, angiogenesis and immune-suppression. A growing body of evidences supports the presence of tuning mechanisms in order to skew or restraint the inflammatory response of TAMs and thus forces them to function as active tumor-promoting immune cells. The receptor of advanced glycation end-products (RAGE) is a member of the immunoglobulin protein family of cell surface molecules, being activated by several danger signals and thus signaling to promote the production of many pro-inflammatory molecules. Interestingly, this receptor is paradoxically expressed in both M1 and M2 macrophages phenotypes. This review addresses how RAGE signaling has been drifted away in M2 macrophages, and thus taking advantage of the abundance of RAGE ligands at tumor microenvironment, particularly HMGB1, to reinforce the supportive M2 macrophages strategy to support tumor growth.

Procedure Time Comparison between Radial Versus Femoral Access in ST-Segment Elevation Acute Myocardial Infarction Patients Undergoing Emergent Percutaneous Coronary Intervention: A Meta-analysis of Controlled Randomized Trials.

INTRODUCTION: There are inconclusive data about the potential delay of procedure time in emergent percutaneous coronary intervention (PCI) by radial compared with femoral approach in patients with ST-segment elevation myocardial infarction (STEMI). AIMS: The purpose of the current study is to conduct a comprehensive meta-analysis of controlled randomized trials (CRTs) comparing the procedure time in STEMI patients undergoing emergent PCI with radial versus femoral access. METHODS: Formal search of CRTs through electronic databases (Medline and PubMed) was performed from January 1990 to October 2014 without language restrictions. Mean difference (MD) of procedure time was evaluated as overall effect. RESULTS: Twelve studies were included with 2052 and 2121 patients in radial and femoral group, respectively. Variability in the definition of procedure time was found with unavailability of a precise definition in 41.6% of studies. When all studies were included, no significant longer procedure time in radial approach was detected (MD [95% confidence interval [CI] = 1.6 min [-0.10, 3.3], P = 0.07, P het = 0.56). After deleting RIVAL trial, procedure time was significantly longer in radial group (MD [95% CI] = 1.5 min [0.71, 2.3], P < 0.001, P het = 0.20). Meta-analysis of three studies with similar definition of procedure time showed (MD [95% CI] = 1.26 min [-0.43, 2.95], P = 0.14, P het = 0.85). CONCLUSIONS: Although the procedure time in STEMI patients undergoing emergent PCI by radial access is generally comparable with femoral approach, there is an absence of uniformity in its definition, which leads to divergent results. A standardized definition of procedure time is required to elucidate this relevant matter.

Marcadores angiográficos negativos en la intervención coronaria percutánea de las oclusiones totales crónicas / Negative angiographic markers in percutaneous coronary intervention of chronic total occlusions

Resumen Objetivos: El objetivo de este estudio es evaluar variables angiográficas predictivas negativas y la presencia de la rama lateral en la proximidad de la capa distal de la oclusión en el resultado de la intervención coronaria percutánea de las oclusiones totales crónicas. Método: Las variables angiográficas potencialmente negativas fueron evaluadas retrospectivamente en 156 oclusiones totales crónicas sometidas a intervención coronaria percutánea. Se utilizó regresión logística binaria con una finalidad predictiva para identificar un modelo de variables que en su conjunto puedan predecir satisfactoriamente el resultado negativo de la intervención. Resultados: Las variables asociadas de forma independiente al fracaso de procedimiento fueron la enfermedad multivaso (odds ratio = 5,12; intervalo de confianza del 95%, 1,94-13,5; P = 0.001), la presencia de muñón ambiguo (odds ratio = 5,08; IC intervalo de confianza del 95%, 2,22- 11,63; P < 0.001), longitud de la oclusión ≥20 mm (odds ratio = 3,7; IC intervalo de confianza del 95%, 1,37-9,97; P = 0.01) y la localización ostial de la oclusión (odds ratio = 6,53; intervalo de confianza del 95%, 1,67-25,63; P = 0.007). La rama lateral en la proximidad de la capa distal no permaneció en el modelo predictivo. Conclusión: La enfermedad multivaso, muñón ambiguo, una longitud ≥20 mm y la localización ostial son factores independientes y predictivos de un resultado desfavorable de la angioplastia. La rama lateral en la capa distal de la oclusión no se asoció al fracaso de la intervención. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Objective: The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. Methods: Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. Results: Variables independently associated with the procedural failure were multivessel disease (odds ratio = 5.12; 95% confidence interval (CI); 1.94-13.5; P = .001), ambiguous stump presence (odds ratio = 5.08; 95% CI; 2.22-11.63 P < .001), occlusion length ≥20 mm (odds ratio = 3.7; 95% CI; 1.37-9.97 P = .01), and ostial location (odds ratio = 6.53; 95% CI; 1.67-25.63; P = .007). Side branch at distal cap proximity did not remain in the predictive model. Conclusions: Multivessel disease, ambiguous stump, a length ≥20 mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Tentativa de suicídio entre pessoas com transtornos mentais e comportamentais / Suicide attempts among people with mental and behavioral disorders

Objetivo: investigar a relação tentativa de suicídio e características sociodemográficas e psiquiátricas de pacientes com transtornos psiquiátricos. Método: estudo quantitativo, transversal, com 410 pacientes atendidos em um Centro de Atenção Psicossocial. Os dados foram analisados por meio de estatística descritiva e inferencial e tabulados no SPSS, versão 21.0. Resultados: dentre os 410 prontuários analisados, foram encontrados 22,9% dos prontuários com registro de tentativa de suicídio. A tentativa de suicídio foi mais frequente em homens, adultos, entre 19 e 59 anos, sem vínculo matrimonial, com baixa escolaridade e inatividade laboral. Ainda se identificou associação de tentativa de suicídio com comorbidade psiquiátrica e história de abuso físico ou sexual, acidente ou violência doméstica, violências, acidentes, perdas importantes, perdas ou separação dos pais e conflitos familiares. Conclusão: pacientes em tratamento no centro de atenção psicossocial com comorbidade psiquiátrica e história de experiência traumática apresentam maior risco de comportamento suicida.(AU)

Características e fatores de risco do comportamento suicida entre homens e mulheres com transtornos psiquiátricos / Characteristics and risk factors for suicidal behavior among men and women with psychiatric disorders / Características y factores de riesgo del comportamiento suicida entre hombres y mujeres con trastornos psiquiátricos

Objetivo: identificar características do comportamento suicida e fatores de risco de homens e mulheres com transtornos psiquiátricos. Método: estudo quantitativo de 410 prontuários de pacientes psiquiátricos em tratamento, de 1997 a 2014, com análise descritiva e inferencial dos prontuários do serviço, no período de abril a dezembro de 2015, em um Centro de Atenção Psicossocial de Divinópolis/Minas Gerais. Resultado: uma maior frequência do comportamento suicida entre as mulheres foi, também, o motivo mais frequente de admissão para tratamento no serviço. A autointoxicação foi mais comum nas mulheres e o enforcamento, nos homens. Na admissão de pacientes com comportamento suicida, foram característicos, das mulheres, o transtorno do humor e, dos homens, os transtornos devido ao uso de substâncias psicoativas. O histórico familiar de suicídio associou- se ao comportamento suicida dos homens e à história de abuso físico ou sexual das mulheres. Conclusão: evidenciaram-se particularidades do comportamento suicida entre pacientes psiquiátricos em tratamento em relação ao sexo (AU).

Objective: to identify characteristics of suicidal behavior and risk factors among men and women with psychiatric disorders. Method: quantitative study of 410 medical records of psychiatric patients receiving treatment, from 1997 to 2014, with descriptive and inferential analysis of the service's medical records. Undertaken between April ­ December 2015, in a Psychosocial Care Center in Divinópolis, in the Brazilian state of Minas Gerais. Result: the higher frequency of suicidal behavior among women was, also, the most frequent reason for admission for treatment in the service. Self-poisoning was more common among the women, while hanging was more common among the men. Upon admission for suicidal behavior, the women's characteristics were mood disorders, and the men's were disorders due to the use of psychoactive substances. Suicidal behavior in men was associated with family history of suicide, while among women, it was associated with physical or sexual abuse. Conclusion: Evidence was found for specific characteristics of suicidal behavior among psychiatric patients receiving treatment in relation to gender (AU).

Objetivo: identificar características del comportamiento suicida y factores de riesgo de hombres y mujeres con trastornos psiquiátricos. Método: estudio cuantitativo de 410 prontuarios de pacientes psiquiátricos en tratamiento, de 1997 a 2014, con análisis descriptivo y de inferencia de los prontuarios del servicio, en el periodo de abril a diciembre de 2015, en un Centro de Atención Psicosocial de Divinópolis/Minas Gerais. Resultado: una mayor frecuencia del comportamiento suicida entre las mujeres fue, también, el motivo más frecuente de admisión para tratamiento en el servicio. La autointoxicación fue más común en las mujeres y el ahorcamiento, en los hombres. En la admisión de pacientes con comportamiento suicida, fueron característicos, de las mujeres, el trastorno do humor y, de los hombres, los trastornos a causa del uso de substancias psicoactivas. El histórico familiar de suicidio se asoció al comportamiento suicida de los hombres y a la historia de abuso físico o sexual de las mujeres. Conclusión: se evidenciaron particularidades del comportamiento suicida entre pacientes psiquiátricos en tratamiento acerca del sexo (AU).

Saúde on-line: impacto na prevalência de obesidade e satisfação corporal de adolescentes / Online health: impact on the prevalence of obesity and body satisfaction of adolescents

Objetivo: avaliar o efeito de ação de educação em saúde, conduzida pelo Facebook, na prevalência de sobrepeso/obesidade e na satisfação corporal de adolescentes, bem como a relação de concordância entre estas medidas e as diferenças em adolescentes. Método: estudo quantitativo, ensaio não controlado, em que 69 adolescentes de ambos os sexos, dos 13 aos 19 anos, foram avaliados em 4 meses quanto ao estado nutricional e percepção corporal, antes e depois de intervenção de educação em saúde sobre nutrição. Resultados: 20,8% estavam com excesso de peso, 20,3% se percebiam com excesso de peso e 36,2% apresentavam insatisfação corporal. Houve maior prevalência de insatisfação corporal entre adolescentes do sexo feminino com sobrepeso/obesidade. Conclusão: não se evidenciou impacto estatisticamente significativo da estratégia de educação em saúde executada na prevalência de sobrepeso/obesidade e na satisfação com a imagem corporal. Discutem-se os fatores associados com o baixo impacto da intervenção e a importância de estudos dessa natureza, visto que a obesidade é multideterminada, o que implica a necessidade de que abordagens utilizadas para a prevenção e o controle desse agravo sejam avaliadas quanto a seus sucessos e insucessos para que sejam aprimoradas em estudos futuros.(AU)

[Negative angiographic markers in percutaneous coronary intervention of chronic total occlusions]. / Marcadores angiográficos negativos en la intervención coronaria percutánea de las oclusiones totales crónicas.

OBJECTIVE: The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. METHODS: Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. RESULTS: Variables independently associated with the procedural failure were multivessel disease (odds ratio=5.12; 95% confidence interval (CI); 1.94-13.5; P=.001), ambiguous stump presence (odds ratio=5.08; 95% CI; 2.22-11.63 P<.001), occlusion length ≥20mm (odds ratio=3.7; 95% CI; 1.37-9.97 P=.01), and ostial location (odds ratio=6.53; 95% CI; 1.67-25.63; P=.007). Side branch at distal cap proximity did not remain in the predictive model. CONCLUSIONS: Multivessel disease, ambiguous stump, a length ≥20mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure.

Lysyl oxidase isoforms in gastric cancer.

Gastric cancer (GC) is the fifth most frequent cancer in the world and shows the highest incidence in Latin America and Asia. An increasing amount of evidence demonstrates that lysyl oxidase isoforms, a group of extracellular matrix crosslinking enzymes, should be considered as potential biomarkers and therapeutic targets in GC. In this review, we focus on the expression levels of lysyl oxidase isoforms, its functions and the clinical implications in GC. Finding novel proteins related to the processing of these extracellular matrix enzymes might be helpful in the design of new therapies, which, in combination with classic pharmacology, could be used to delay the progress of this aggressive cancer and offer a wider temporal window for clinical intervention.

HMGB1 enhances the protumoral activities of M2 macrophages by a RAGE-dependent mechanism.

The monocyte-macrophage lineage shows a high degree of diversity and plasticity. Once they infiltrate tissues, they may acquire two main functional phenotypes, being known as the classically activated type 1 macrophages (M1) and the alternative activated type 2 macrophages (M2). The M1 phenotype can be induced by bacterial products and interferon-γ and exerts a cytotoxic effect on cancer cells. Conversely, the alternatively activated M2 phenotype is induced by Il-4/IL13 and promotes tumor cell growth and vascularization. Although receptor for advanced glycation end-products (RAGE) engagement in M1 macrophages has been reported by several groups to promote inflammation, nothing is known about the functionality of RAGE in M2 macrophages. In the current study, we demonstrate that RAGE is equally expressed in both macrophage phenotypes and that RAGE activation by high-mobility group protein box1 (HMGB1) promotes protumoral activities of M2 macrophages. MKN45 cells co-cultured with M2 macrophages treated with HMGB1 at different times displayed higher invasive abilities. Additionally, conditioned medium from HMGB1-treated M2 macrophages promotes angiogenesis in vitro. RAGE-targeting knockdown abrogates these activities. Overall, the present findings suggest that HMGB1 may contribute, by a RAGE-dependent mechanism, to the protumoral activities of the M2 phenotype.

Troponina elevada en pacientes sin síndrome coronario agudo / Troponin Elevation in patients without acute coronary syndrome

Introducción y objetivos: Las troponinas son biomarcadores específicos de daño miocárdico y tienen implicación en el diagnóstico y el pronóstico de pacientes con síndrome coronario agudo. El objetivo es determinar las características clínicas y el pronóstico en pacientes con elevación de troponina no diagnosticados de síndrome coronario agudo. Métodos: Se estudió retrospectivamente a 1.032 pacientes con determinación de troponinas en un servicio de urgencias, que quedaron distribuidos en tres grupos: 681 pacientes sin elevación de troponina y sin síndrome coronario agudo, 139 con síndrome coronario agudo y 212 con troponina elevada sin diagnóstico de síndrome coronario agudo. Se compararon las características clínicas de estos tres grupos y su mortalidad hospitalaria y a los 12 meses de seguimiento. Conclusiones: La troponina elevada es un importante predictor de mortalidad, independientemente del diagnóstico definitivo del paciente (AU)

Introduction and objectives: Troponins are specific biomarkers of myocardial injury and are implicated in the diagnosis and prognosis of patients with acute coronary syndrome. Our purpose was to determine the clinical characteristics and prognosis of patients with troponin elevation who are not diagnosed with acute coronary syndrome. Methods: A total of 1032 patients with an emergency room troponin measurement were studied retrospectively, dividing them into 3 groups: 681 patients with no troponin elevation and without acute coronary syndrome, 139 with acute coronary syndrome, and 212 with troponin elevation and not diagnosed with acute coronary syndrome. The clinical characteristics and in-hospital and 12-month mortality of these 3 groups were compared. Results: Patients with troponin elevation not diagnosed with acute coronary syndrome were older and had greater comorbidity than patients with acute coronary syndrome or no troponin elevation. The 12-month mortality was 30.2%, compared with 15.1% and 4.7% in the other groups (log rank test, P < .001). In the Cox logistic regression model adjusted for confounding variables, patients with troponin elevation and no diagnosis of acute coronary syndrome had higher mortality compared with patients with negative troponin without acute coronary syndrome (hazard ratio = 3.99; 95% confidence interval, 2.36-6.75; P < .001) and similar prognosis as patients with acute coronary syndrome. Conclusions: Troponin elevation is an important predictor of mortality, regardless of the patient's final diagnosis (AU)

Troponin elevation in patients without acute coronary syndrome.

INTRODUCTION AND OBJECTIVES: Troponins are specific biomarkers of myocardial injury and are implicated in the diagnosis and prognosis of patients with acute coronary syndrome. Our purpose was to determine the clinical characteristics and prognosis of patients with troponin elevation who are not diagnosed with acute coronary syndrome. METHODS: A total of 1032 patients with an emergency room troponin measurement were studied retrospectively, dividing them into 3 groups: 681 patients with no troponin elevation and without acute coronary syndrome, 139 with acute coronary syndrome, and 212 with troponin elevation and not diagnosed with acute coronary syndrome. The clinical characteristics and in-hospital and 12-month mortality of these 3 groups were compared. RESULTS: Patients with troponin elevation not diagnosed with acute coronary syndrome were older and had greater comorbidity than patients with acute coronary syndrome or no troponin elevation. The 12-month mortality was 30.2%, compared with 15.1% and 4.7% in the other groups (log rank test, P<.001). In the Cox logistic regression model adjusted for confounding variables, patients with troponin elevation and no diagnosis of acute coronary syndrome had higher mortality compared with patients with negative troponin without acute coronary syndrome (hazard ratio=3.99; 95% confidence interval, 2.36-6.75; P<.001) and similar prognosis as patients with acute coronary syndrome. CONCLUSIONS: Troponin elevation is an important predictor of mortality, regardless of the patient's final diagnosis.