Prevalence of pressure injury and associated factors in hospitalized adult patients with cancer.

INTRODUCTION: Hospitalized cancer patients experience limitations in their daily activities resulting from the severity of their condition. Such changes alter patients' sensory perception and hinder their mobility, thus predisposing them to the development of PI. OBJECTIVE: The goal of this study was to analyze the prevalence of PI and associated factors in hospitalized cancer patients. MATERIALS AND METHODS: This observational, epidemiological, cross-sectional, descriptive study was carried out in the inpatient and ICU settings of an oncological hospital in São Paulo, Brazil. RESULTS: A total of 341 patients who met the inclusion criteria and agreed to participate in the study were interviewed and assessed. Data obtained in the interviews were analyzed for logistic regression analysis. Pressure injury prevalence was 10% (34 patients). The use of disposable diapers was significantly associated with the development of PI, with a 6.077 increased chance of PI in such patients in the ICU setting. In this epidemiologic study of 341 hospitalized cancer patients, the prevalence of PI was 10%. The use of disposable diapers was the only factor associated with the presence of PI after logistic regression analysis. CONCLUSION: Knowing the risk factors of this specific population was essential to implement actions and optimize indications of disposable diaper use. There is an absence of epidemiologic records due to limited publications available on the subject; creating a program to prevent PI development within the inpatient, assisted population.

The prevalence of skin lesions and associated factors in hospitalised adult patients with cancer.

OBJECTIVE: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. METHOD: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. RESULTS: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. CONCLUSION: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures.

The prevalence of skin tears and associated factors in hospitalised patients with cancer.

OBJECTIVE: Oncology patients are vulnerable to skin breakdown. The primary purpose of this study was to estimate the prevalence of skin tears (STs) in hospitalised patients with cancer and to explore related sociodemographic and clinical factors. METHOD: This was an observational, epidemiological, cross-sectional study conducted in an oncology hospital in the city of São Paulo. All STs were classified using the STAR Classification adapted and validated for Brazil. RESULTS: Of the 341 patients evaluated, 22 had STs, equating to a prevalence of 6.5%. A higher number of STs were noted on the lower limbs (26.9%) than on other body areas. The main factors associated with STs were the use of anticoagulants, the presence of ecchymosis and the use of incontinence briefs. CONCLUSION: This study contributed to a better understanding of the epidemiology of STs in hospitalised patients with cancer, as well as its associated factors. Results may inform nursing professionals with regard to the need to develop prevention strategies and early interventions.

Cultural Adaptation and Validation of the Ostomy Adjustment Inventory-23 for Brazil.

The Ostomy Adjustment Inventory-23 (OAI-23) was developed in English to measure the social and psychological adaptation of individuals who underwent ostomy surgeries. PURPOSE: The aim of the current study was to culturally adapt and test the measurement properties of a Brazilian Portuguese adapted version of the OAI-23. METHODS: The original version of the OAI-23 was composed of 23 questions distributed into the following 4 factors: acceptance, anxiety/preoccupation, social engagement, and anger. The OAI-23 was translated into Portuguese, reviewed by a committee of expert reviewers, pretested on a focus group, and back-translated. Using convenience sampling methods, patients who were treated at specialized health centers located in different parts of Brazil were invited to complete a demographic and health history questionnaire, the Janis and Field Self-Esteem Scale, and the adapted version of OAI-23 to assess its reliability, convergent construct validity, and discriminant construct validity. RESULTS: A total of 191 patients with a mean age of 58.9 years (SD = 14.7) (74.1% with colostomies, 19.6% with ileostomies, and 6.3% with urostomies) participated in the study. The Brazilian Portuguese adapted version of the OAI-23 had a Cronbach's alpha coefficient of 0.846 and an intra-class correlation coefficient of 0.903 (P < .001). Significant correlations between OAI-23 scores and self-esteem scale scores confirmed the convergent construct validity, and the instrument was able to discriminate patients' adjustment according to age. CONCLUSION: The adapted version of the OAI-23 proved to be reliable and valid for use in Brazil; this represents the first instrument capable of assessing psychosocial adaptation of patients with stomas in that country.

Complicated Surgical Wounds and Associated Factors in Oncology Patients.

The objective of this study was to identify the occurrence of complicated surgical wounds (CSWs) and to analyze the associated factors in hospitalized patients at an oncology institution. This was an epidemiological, observational, cross-sectional, descriptive, and correlational study conducted in the intensive care and hospitalization units forming part of a large cancer hospital. Sociodemographic and clinical data were collected from medical records and physical examinations of the skin. Associations between the dependent variable (presence of CSWs) and the independent variables were obtained by chi-square tests and odds ratio (OR) calculations with a 95% confidence interval. Logistic regression (LASSO) was used to verify the possible predictors of the outcome. The sample consisted of 341 patients, specifically individuals who are White (46.9%), married (53.4%), and men (58.1%) with an average age of 59.2 years. Complicated surgical wounds were present in 3.2% of patients, and the most frequent types of complications were dehiscence (40%), infection (26.7%), and fistula (20%) present in the abdominal (40%), cephalic (26.7%), and cervical (13.3%) regions. Senile purpura, diaper use, and infection were the clinical variables associated with the occurrence of CSWs (p = .044, p = .001, and p < .001, respectively). Based on the logistic regression, the presence of infection (p < .001; OR = 90.8; 95% CI [18.42, 538.79]) persisted as a predictor of the occurrence of CSWs. From these observations, recommendations regarding best practices for the prevention of CSWs are made, specifically for patients with cancer.

Identification of midgut membrane proteins from different instars of Helicoverpa armigera (Lepidoptera: Noctuidae) that bind to Cry1Ac toxin.

Helicoverpa armigera is a polyphagous pest sensitive to Cry1Ac protein from Bacillus thuringiensis (Bt). The susceptibility of the different larval instars of H. armigera to Cry1Ac protoxin showed a significant 45-fold reduction in late instars compared to early instars. A possible hypothesis is that gut surface proteins that bind to Cry1Ac differ in both instars, although higher Cry toxin degradation in late instars could also explain the observed differences in susceptibility. Here we compared the Cry1Ac-binding proteins from second and fifth instars by pull-down assays and liquid chromatography coupled to mass spectrometry analysis (LC-MS/MS). The data show differential protein interaction patterns of Cry1Ac in the two instars analyzed. Alkaline phosphatase, and other membrane proteins, such as prohibitin and an anion selective channel protein were identified only in the second instar, suggesting that these proteins may be involved in the higher toxicity of Cry1Ac in early instars of H. armigera. Eleven Cry1Ac binindg proteins were identified exclusively in late instar larvae, like different proteases such as trypsin-like protease, azurocidin-like proteinase, and carboxypeptidase. Different aminopeptidase N isofroms were identified in both instar larvae. We compared the Cry1Ac protoxin degradation using midgut juice from late and early instars, showing that the midgut juice from late instars is more efficient to degrade Cry1Ac protoxin than that of early instars, suggesting that increased proteolytic activity on the toxin could also explain the low Cry1Ac toxicity in late instars.

Incidence of Infusion Site Reactions in Peripheral Fosaprepitant Infusions.

Fosaprepitant is administered intravenously to treat chemotherapy-induced nausea and vomiting. To verify the incidence of infusion site reactions and the relationship among risk factors, a quantitative retrospective cohort study was undertaken. The study included patients seen between October 2013 and February 2014. Fifty-seven patients were included in the study, and there were 105 infusions among them. Infusion site reactions were identified in 42 (40%) cases. Risk factors identified by the study included age (P < .001), insertion at the back of the hand and wrist (P < .001), and first fosaprepitant administration (P < .001). The study found evidence of a higher incidence of infusion site reactions than was reported in the package insert.

Identification of Bacillus thuringiensis Cry1AbMod binding-proteins from Spodoptera frugiperda.

Bacillus thuringiensis Cry toxins are currently used for pest control in transgenic crops but evolution of resistance by the insect pests threatens the use of this technology. The Cry1AbMod toxin was engineered to lack the alpha helix-1 of the parental Cry1Ab toxin and was shown to counter resistance to Cry1Ab and Cry1Ac toxins in different insect species including the fall armyworm Spodoptera frugiperda. In addition, Cry1AbMod showed enhanced toxicity to Cry1Ab-susceptible S. frugiperda populations. To gain insights into the mechanisms of this Cry1AbMod-enhanced toxicity, we isolated the Cry1AbMod toxin binding proteins from S. frugiperda brush border membrane vesicles (BBMV), which were identified by pull-down assay and liquid chromatography-tandem mass spectrometry (LC-MS/MS). The LC-MS/MS results indicated that Cry1AbMod toxin could bind to four classes of aminopeptidase (N1, N3, N4 y N5) and actin, with the highest amino acid sequence coverage acquired for APN 1 and APN4. In addition to these proteins, we found other proteins not previously described as Cry toxin binding proteins. This is the first report that suggests the interaction between Cry1AbMod and APN in S. frugiperda.

Toxicity of Cry1A toxins from Bacillus thuringiensis to CF1 cells does not involve activation of adenylate cyclase/PKA signaling pathway.

Bacillus thuringiensis (Bt) bacteria produce Cry toxins that are able to kill insect pests. Different models explaining the mode of action of these toxins have been proposed. The pore formation model proposes that the toxin creates pores in the membrane of the larval midgut cells after interaction with different receptors such as cadherin, aminopeptidase N and alkaline phosphatase and that this pore formation activity is responsible for the toxicity of these proteins. The alternative model proposes that interaction with cadherin receptor triggers an intracellular cascade response involving protein G, adenylate cyclase (AC) and protein kinase A (PKA). In addition, it was shown that Cry toxins induce a defense response in the larvae involving the activation of mitogen-activated kinases such as MAPK p38 in different insect orders. Here we analyzed the mechanism of action of Cry1Ab and Cry1Ac toxins and a collection of mutants from these toxins in the insect cell line CF1 from Choristoneura fumiferana, that is naturally sensitive to these toxins. Our results show that both toxins induced permeability of K+ ions into the cells. The initial response after intoxication with Cry1Ab and Cry1Ac toxins involves the activation of a defense response that involves the phosphorylation of MAPK p38. Analysis of activation of PKA and AC activities indicated that the signal transduction involving PKA, AC and cAMP was not activated during Cry1Ab or Cry1Ac intoxication. In contrast we show that Cry1Ab and Cry1Ac activate apoptosis. These data indicate that Cry toxins can induce an apoptotic death response not related with AC/PKA activation. Since Cry1Ab and Cry1Ac toxins affected K+ ion permeability into the cells, and that mutant toxins affected in pore formation are not toxic to CF1, we propose that pore formation activity of the toxins is responsible of triggering cell death response in CF1cells.

mRNA and protein dataset of autophagy markers (LC3 and p62) in several cell lines.

We characterized the dynamics of autophagy in vitro using four different cell systems and analyzing markers widely used in this field, i.e. LC3 (microtubule-associated protein 1 light chain 3; protein recruited from the cytosol (LC3-I) to the autophagosomal membrane where it is lipidated (LC3-II)) and p62/SQSTM1 (adaptor protein that serves as a link between LC3 and ubiquitinated substrates), (Klionsky et al., 2016) [1]. Data provided include analyses of protein levels of LC3 and p62 by Western-blotting and endogenous immunofluorescence experiments, but also p62 mRNA levels obtained by quantitative PCR (qPCR). To monitor the turnover of these autophagy markers and, thus, measure the flux of this pathway, cells were under starvation conditions and/or treated with bafilomycin A1 (Baf. A1) to block fusion of autophagosomes with lysosomes.

Efficient production of Bacillus thuringiensis Cry1AMod toxins under regulation of cry3Aa promoter and single cysteine mutations in the protoxin region.

Bacillus thuringiensis Cry1AbMod toxins are engineered versions of Cry1Ab that lack the amino-terminal end, including domain I helix α-1 and part of helix α-2. This deletion improves oligomerization of these toxins in solution in the absence of cadherin receptor and counters resistance to Cry1A toxins in different lepidopteran insects, suggesting that oligomerization plays a major role in their toxicity. However, Cry1AbMod toxins are toxic to Escherichia coli cells, since the cry1A promoter that drives its expression in B. thuringiensis has readthrough expression activity in E. coli, making difficult the construction of these CryMod toxins. In this work, we show that Cry1AbMod and Cry1AcMod toxins can be cloned efficiently under regulation of the cry3A promoter region to drive its expression in B. thuringiensis without expression in E. coli cells. However, p3A-Cry1Ab(c)Mod construction promotes the formation of Cry1AMod crystals in B. thuringiensis cells that were not soluble at pH 10.5 and showed no toxicity to Plutella xylostella larvae. Cysteine residues in the protoxin carboxyl-terminal end of Cry1A toxins have been shown to be involved in disulfide bond formation, which is important for crystallization. Six individual cysteine substitutions for serine residues were constructed in the carboxyl-terminal protoxin end of the p3A-Cry1AbMod construct and one in the carboxyl-terminal protoxin end of p3A-Cry1AcMod. Interestingly, p3A-Cry1AbMod C654S and C729S and p3A-Cry1AcMod C730S recover crystal solubility at pH 10.5 and toxicity to P. xylostella. These results show that combining the cry3A promoter expression system with single cysteine mutations is a useful system for efficient expression of Cry1AMod toxins in B. thuringiensis.

Diferentes tipos de incidencia de los procesos cognitivos de revisión sobre la coherencia de textos narrativos: un estudio con niños de 10 años / Different types of incidence that revision cognitive processes have on narrative texts coherence: a research with ten-year-old children

Esta investigación se enmarca en la Psicología del Desarrollo Cognitivo, su propósito es identificar los procesos de revisión en las reescrituras elaboradas por niños de 10 años y su incidencia en el establecimiento de la coherencia de textos narrativos. El análisis cualitativo y estadístico de tres producciones escritas y dos conversatorios de 30 niños de 10 años, permite identificar tanto los diferentes tipos de incidencia que tiene la revisión sobre la coherencia, como las trayectorias que siguen los niños para lograr transformaciones a nivel estructural y discursivo. El análisis de los cambios que los niños realizan en sus producciones escritas, permite conocer las transformaciones en la coherencia y da cuenta de avances, retrocesos, oscilaciones y permanencia en los desempeños. Finalmente, se identifican funcionamientos mentales decisivos en el establecimiento de la coherencia y dimensiona la importancia de propuestas educativas que focalicen en la revisión.

The following research stands within the framework of cognitive development psychology. Its purpose is to identify how the revision process works in the re-writings done by ten-year-old children, and the incidence this has on establishing coherence in narrative texts. The qualitative and statistical analysis of three written productions and two conversations held with 30 ten-year-old children enables to identify the different types of incidence that revision has over coherence, as well as the paths followed by children to attain transformations at both structural and discursive levels. Analysis of children's changes in their written productions allows noticing transformations in coherence and it also helps identify the advances, retreats, oscillations, and permanence in the performances. Finally, mental functionings decisive for coherence are identified; the article ends up pointing out the importance of having educational proposals that focus on revision.