Actinomycosis in the maxilla of a young asymptomatic patient: unusual case report / Actinomicose em maxila de um paciente jovem assintomático: relato de caso incomum

ABSTRACT The aim of this study is to report an unusual case of actinomycosis in the maxilla region of an asymptomatic patient. A 21-year-old white man was referred for the analysis of panoramic radiography and cone beam computed tomography, where it was observed the presence of a hypodense lesion on the left side of the maxilla, which extended from the maxillary left central incisor to the region of the maxillary left second premolar. During intraoral examination, a depression was observed in the hard palate mucosa, as well as a fistula in the alveolar mucosa close to maxillary left central incisor, which had pulp vitality confirmed by thermal tests. A fistulography was performed, with periapical radiography, where it was found that the fistulous path did not originate from the tooth mentioned above. An incisional biopsy was performed for diagnostic purposes. However, given the inconclusive microscopic findings, four months later, a new biopsy was performed. The histopathological examination revealed the presence of a colony of microoganisms with filamentous pattern of radiated rosette, surrounded by polymorphonuclear inflammatory cells. Based on the morphological characteristics, the diagnosis of actinomycosis was established. The treatment was based on antibiotic therapy. Six months after treatment of the infection, no signs of recurrence were observed, and the patient remains in follow-up. Actinomycosis in the maxilla is an uncommon infection with a predilection for males between the ages of 20 and 60, whose treatment is antibiotic therapy associated or not with surgical excision.

RESUMO O objetivo deste estudo é relatar um caso incomum de actinomicose em região de maxila de um paciente assintomático. Um homem de 21 anos, branco, foi encaminhado para análise de radiografia panorâmica e tomografia computadorizada de feixe cônico, onde foi observada a presença de lesão hipodensa do lado esquerdo da maxila, que se estendia da região do incisivo central superior esquerdo ao segundo pré-molar superior esquerdo. Ao exame intrabucal, observou-se depressão na mucosa do palato duro, bem como fístula na mucosa alveolar próxima ao incisivo central superior esquerdo, no qual tinha vitalidade pulpar confirmada pelos testes térmicos. Uma fistulografia com radiografia periapical foi realizada, onde foi observado que o trajeto fistuloso não era originado do dente mencionado anteriormente. Foi realizada biópsia incisional para fins diagnósticos. Porém, diante dos achados microscópicos inconclusivos, quatro meses depois, uma nova biópsia foi realizada. O exame histopatológico revelou a presença de colônia de microrganismos com padrão filamentoso de roseta irradiada, circundado por células inflamatórias polimorfonucleares. Com base nas características morfológicas, foi estabelecido o diagnóstico de actinomicose. O tratamento foi baseado em antibioticoterapia. Seis meses após o tratamento da infecção, não foram observados sinais de recidiva e o paciente permanece em acompanhamento. A actinomicose da maxila é uma infecção incomum, com predileção por pacientes do sexo masculino com idade entre 20 e 60 anos, cujo tratamento é antibioticoterapia associada ou não à excisão cirúrgica.

Immunoexpression of proliferation and apoptosis markers in oral vascular anomalies.

The biological behavior of lesions is highly dependent on the imbalance between their proliferative and apoptotic capacity. This study evaluated a correlation between the proliferative and apoptotic rates of different oral vascular anomalies (VAs) by analyzing the immunoexpression of proliferation (Ki-67) and apoptosis (Bcl-2 and Bax) markers in endothelial cells of 20 cases of GLUT-1 positive infantile hemangiomas (IHs), 20 cases of pyogenic granulomas (PGs) and 20 cases of vascular malformations (VMs). Immunoexpression analysis of Ki-67, Bcl-2 and Bax revealed a lower median percentage of positive cells in VMs cases compared to IHs and PGs cases (P <0.001). The Wilcoxon signed-rank test showed significantly higher percentages of immunostaining for Bax than for Bcl-2 in IHs (P = 0.048). In the group of PGs, a positive correlation was observed between the immunoexpressions of Ki-67 and Bax (r = 0.476; P = 0.034). Although oral IHs, PGs and VMs present similar clinical and histopathological features, each of these lesions has its etiopathogenic particularities. The results of this study suggest that different biological behaviors of VAs may be related to differences in the proliferative and apoptotic profiles of their endothelial cells.

Immunoexpression of proliferation and apoptosis markers in oral vascular anomalies

Abstract The biological behavior of lesions is highly dependent on the imbalance between their proliferative and apoptotic capacity. This study evaluated a correlation between the proliferative and apoptotic rates of different oral vascular anomalies (VAs) by analyzing the immunoexpression of proliferation (Ki-67) and apoptosis (Bcl-2 and Bax) markers in endothelial cells of 20 cases of GLUT-1 positive infantile hemangiomas (IHs), 20 cases of pyogenic granulomas (PGs) and 20 cases of vascular malformations (VMs). Immunoexpression analysis of Ki-67, Bcl-2 and Bax revealed a lower median percentage of positive cells in VMs cases compared to IHs and PGs cases (P <0.001). The Wilcoxon signed‐rank test showed significantly higher percentages of immunostaining for Bax than for Bcl‐2 in IHs (P = 0.048). In the group of PGs, a positive correlation was observed between the immunoexpressions of Ki-67 and Bax (r = 0.476; P = 0.034). Although oral IHs, PGs and VMs present similar clinical and histopathological features, each of these lesions has its etiopathogenic particularities. The results of this study suggest that different biological behaviors of VAs may be related to differences in the proliferative and apoptotic profiles of their endothelial cells.

Resumo O comportamento biológico das lesões é altamente dependente do desequilíbrio entre sua capacidade proliferativa e apoptótica. Neste estudo, avaliou-se se existe correlação entre as taxas proliferativas e apoptóticas de diferentes anomalias vasculares orais (AVs) analisando a imunoexpressão de marcadores de proliferação (Ki-67) e apoptose (Bcl-2 e Bax) em células endoteliais de 20 casos de hemangiomas infantis GLUT-1 positivos (HIs), 20 casos de granulomas piogênicos (GPs) e 20 casos de malformações vasculares (MVs). A análise de imunoexpressão de Ki-67, Bcl-2 e Bax revelou uma porcentagem mediana menor de células positivas nos casos de MVs em comparação aos casos de HIs e GPs (P <0,001). O teste de Wilcoxon mostrou porcentagens significativamente maiores de imunocoloração para Bax do que para Bcl-2 em HIs (P = 0,048). No grupo dos GPs, foi observada correlação positiva entre as imunoexpressões de Ki-67 e Bax (r = 0,476; P = 0,034). Embora HIs, GPs e MVs orais apresentem características clínicas e histopatológicas muito semelhantes, cada uma dessas lesões tem suas particularidades etiopatogênicas. Os resultados deste estudo sugerem que diferentes comportamentos biológicos dos AVs podem estar relacionados a diferenças nos perfis proliferativo e apoptótico de suas células endoteliais.

ING3 and ING4 immunoexpression and their relation to the development of benign odontogenic lesions.

The Inhibitor of Growth (ING) gene family is a group of tumor suppressor genes that play important roles in cell cycle control, senescence, DNA repair, cell proliferation, and apoptosis. However, inactivation and downregulation of these proteins have been related in some neoplasms. The present study aimed to evaluate the immunohistochemical profiles of ING3 and ING4 proteins in a series of benign epithelial odontogenic lesions. METHODS: The sample comprised of 20 odontogenic keratocysts (OKC), 20 ameloblastomas (AM), and 15 adenomatoid odontogenic tumors (AOT) specimens. Nuclear and cytoplasmic immunolabeling of ING3 and ING4 were semi-quantitatively evaluated in epithelial cells of the odontogenic lesions, according to the percentage of immunolabelled cells in each case. Descriptive and statistics analysis were computed, and the p-value was set at 0.05. RESULTS: No statistically significant differences were found in cytoplasmic and nuclear ING3 immunolabeling among the studied lesions. In contrast, AOTs presented higher cytoplasmic and nuclear ING4 labeling compared to AMs (cytoplasmic p-value = 0.01; nuclear p-value < 0.001) and OKCs (nuclear p-value = 0.007). CONCLUSION: ING3 and ING4 protein downregulation may play an important role in the initiation and progression of more aggressive odontogenic lesions, such as AMs and OKCs.

ING3 and ING4 immunoexpression and their relation to the development of benign odontogenic lesions

Abstract The Inhibitor of Growth (ING) gene family is a group of tumor suppressor genes that play important roles in cell cycle control, senescence, DNA repair, cell proliferation, and apoptosis. However, inactivation and downregulation of these proteins have been related in some neoplasms. The present study aimed to evaluate the immunohistochemical profiles of ING3 and ING4 proteins in a series of benign epithelial odontogenic lesions. Methods: The sample comprised of 20 odontogenic keratocysts (OKC), 20 ameloblastomas (AM), and 15 adenomatoid odontogenic tumors (AOT) specimens. Nuclear and cytoplasmic immunolabeling of ING3 and ING4 were semi-quantitatively evaluated in epithelial cells of the odontogenic lesions, according to the percentage of immunolabelled cells in each case. Descriptive and statistics analysis were computed, and the p-value was set at 0.05. Results: No statistically significant differences were found in cytoplasmic and nuclear ING3 immunolabeling among the studied lesions. In contrast, AOTs presented higher cytoplasmic and nuclear ING4 labeling compared to AMs (cytoplasmic p-value = 0.01; nuclear p-value < 0.001) and OKCs (nuclear p-value = 0.007). Conclusion: ING3 and ING4 protein downregulation may play an important role in the initiation and progression of more aggressive odontogenic lesions, such as AMs and OKCs.

Resumo Objetivos: A família dos Genes Inibidores de Crescimento (ING) é um grupo de genes supressores tumorais que desempenham papéis importantes no controle do ciclo celular, na senescência, no reparo do DNA, na proliferação celular e na apoptose. No entanto, a inativação e a regulação negativa dessas proteínas têm sido relacionadas em algumas neoplasias. O objetivo do presente estudo foi avaliar o perfil imuno-histoquímico das proteínas ING3 e ING4 em uma série de lesões odontogênicas epiteliais benignas. Métodos: A amostra foi composta por espécimes de 20 ceratocistos odontogênicos (CO), 20 ameloblastomas (AM) e 15 tumores odontogênicos adenomatoides (TOA). A imunoexpressão nuclear e citoplasmática de ING3 e ING4 foram avaliadas semi-quantitativamente nas células epiteliais das lesões odontogênicas, de acordo com a porcentagem de células imunomarcadas em cada caso. As análises descritivas e estatísticas foram computadas, e o valor de p estabelecido foi de 0,05. Resultados: Não foram encontradas diferenças estatisticamente significativas na imunoexpressão citoplasmática e nuclear de ING3 entre as lesões estudadas. Em contrapartida, os TOAs apresentaram maior marcação citoplasmática e nuclear de ING4 em comparação aos AMs (valor de p citoplasmático=0,01; valor de p nuclear <0,001) e COs (valor nuclear de p=0,007). Conclusão: A regulação negativa das proteínas ING3 e ING4 pode desempenhar um papel importante na iniciação e na progressão de lesões odontogênicas mais agressivas, como AMs e COs.

Uso de agentes naturais no manejo da mucosite oral / Use of natural agents in the management of oral mucositis

A mucosite oral (MO) é uma grave complicação dos tratamentos antineoplásicos, caracterizada pela presença de lesões erosivas e ulcerativas na mucosa oral, que podem causar uma diminuição significativa na qualidade de vida do paciente. Realizar uma revisão de literatura sobre o uso de agentes naturais na prevenção e tratamento da MO induzida por quimioterapia e/ou radioterapia. Artigos científicos foram pesquisados nas bases de dados SciELO, LILACS e Medline/PubMed, utilizando-se os descritores chamomile, propolis, honey, aloe, chemotherapy-induced oral mucositis e phytotherapeutic drug. A partir dessa busca e dos critérios de inclusão adotados, 22 artigos foram selecionados. Na maioria dos estudos analisados, o uso de produtos naturais, como camomila, própolis, mel e aloe vera, foi capaz de diminuir a incidência da MO e a severidade dessas lesões e, além disso, permitiu um melhor controle da dor local, sendo considerada uma boa opção terapêutica. O uso de produtos naturais tornou-se um importante método alternativo para tratamento e prevenção da MO, pois é uma terapia de baixo custo, que apresenta menos reações adversas e que podem ser implementadas pelos profissionais da saúde bucal... (AU)

Oral mucositis (OM) is a serious complication of antineoplastic treatments, characterized by the presence of erosive and ulcerative lesions in the oral mucosa, which may cause a significant decrease in the quality of life of the patient. To perform a literature review about the use of natural agents in the prevention and treatment of OM induced by chemotherapy and/or radiotherapy. Scientific articles were searched in the Scielo, Lilacs and Medline / PubMed databases using the descriptors chamomile, propolis, honey, aloe, chemotherapy-induced oral mucositis and phytotherapeutic drugs. From that research and according to the inclusion criteria, 22 articles were selected to compose this literature review. In most of the analyzed studies, the use of natural products, such as chamomile, propolis, honey and aloe vera was able to decrease the incidence of OM and the severity of these leions, and also allowed a better control of local pain, thus being considered a good therapeutic option. The use of natural products became an important alternative method for the treatment and prevention of OM, since it is a low-cost treatment, which presents less adverse effects and that can be implemented by oral health professionals... (AU)

La mucositis oral (MO) es una complicación grave de los tratamientos antineoplásicos, caracterizada por la presencia de lesiones erosivas y ulcerativas en la mucosa oral, que pueden provocar una disminución significativa de la calidad de vida del paciente. Realizar una revisión de la literatura sobre el uso de agentes naturales en la prevención y el tratamiento de la MO inducida por quimioterapia y / o radioterapia. Se realizaron búsquedas de artículos científicos en las bases de datos SciELO, LILACS y Medline/PubMed, utilizando los descriptores Manzanilla; Própolis; Miel; Aloe; Estomatitis; Medicamentos Fitoterápicos. De esta búsqueda y de los criterios de inclusión adoptados se seleccionaron 22 artículos. En la mayoría de los estudios analizados, el uso de productos naturales, como manzanilla, própolis, miel y aloe vera, consiguió reducir la incidencia de MO y la gravedad de estas lesiones y, además, permitió un mejor control del dolor local, siendo considerada una buena opción terapéutica. El uso de productos naturales se ha convertido en un método alternativo importante para el tratamiento y prevención de la MO, por ser una terapia de bajo costo, que tiene menos reacciones adversas y que puede ser implementada por profesionales de la salud bucal... (AU)

A 46-Year Retrospective Study of Oral Vascular Anomalies in a Brazilian Population

ABSTRACT: A retrospective study was performed to describe the demographic and clinicopathological characteristics of cases of vascular anomalies in a Brazilian population. The data of cases diagnosed as vascular anomalies over a period of 46 years, were retrieved from the archives of the Pathological Anatomy Service of the Department of Dentistry of Federal University of Rio Grande do Norte. Information about sex, age, race, diagnosis, location, and clinical characteristics was extracted. A database was created for analysis in the SPSS system and description of the results. The sample consisted of 597 cases categorized as follows: pyogenic granuloma (n = 454), infantile hemangioma (n = 57), vascular malformation (n = 37), lymphangioma (n = 20), hemangiolymph angioma (n = 10), vascular thrombus (n = 7), hemangio endothelioma (n = 5), angiofibroma (n = 1), hemangioendothelio sarcoma (n = 1), and Kaposi sarcoma (n = 5). Overall, there was a predominance of females (64.2 %), white race (54.2 %), and patients in the 3rd and 4th decades of life. Most cases affected the gingiva/ ridge (44.75 %), had a red/reddish color (60.07 %), sessile implantation (52.4 %), soft consistency (52.7 %) and nodular appearance (53, 9 %), and were non-hemorrhagic (51.3 %) and asymptomatic (76.6 %). The demographic and clinicopathological findings obtained for most of the vascular lesions analyzed are similar to those reported in published studies involving other populations. Knowledge of the particularities of these disorders is important for appropriate diagnosis and treatment decision.

RESUMEN: Se realizó un estudio retrospectivo para describir las características demográficas y clínico-patológicas de casos de anomalías vasculares en una población brasileña. Los datos de los casos diagnosticados como anomalías vasculares durante un período de 46 años, fueron obtenidos de los archivos del Servicio de Anatomía Patológica del Departamento de Odontología de la Universidade Federal de Rio Grande do Norte. Se analizó la información de sexo, edad, raza, diagnóstico, ubicación y características clínicas, y se creó una base de datos para análisis en el sistema SPSS y descripción de los resultados. La muestra consistió de 597 casos categorizados de la siguiente manera: granuloma piógeno (n = 454), hemangioma infantil (n = 57), malformación vascular (n = 37), linfangioma (n = 20), hemangiolinfangioma (n = 10), trombo vascular (n = 7), hemangioendotelioma (n = 5), angiofibroma (n = 1), hemangioendoteliosarcoma (n = 1) y sarcoma de Kaposi (n = 5). En general predominaron las mujeres de raza blanca (64,2 %), (54,2 %), y pacientes en la 3ª y 4ª década de la vida. La mayoría de los casos afectaban la encía / cresta (44,75 %), tenían un color rojo / rojizo (60,07 %), implantación sésil (52,4 %), consistencia blanda (52,7 %) y apariencia nodular (53,9 %), no hemorrágicos (51,3 %) y asintomáticos (76,6 %). Los hallazgos demográficos y clínico-patológicos de la mayoría de las lesiones vasculares analizadas son similares a los reportados en la literatura de otras poblaciones. El conocimiento de las particularidades de estos trastornos es importante para el diagnóstico y la decisión de tratamientos adecuados.

Intervenção de enfermagem de reabilitação após artroplastia total da anca: revisão sistemática da literatura / Rehabilitation nursing intervention after total hip arthroplasty: a systematic review of the literature

O presente trabalho prende-se com a temática "Intervenção de Enfermagem de Reabilitação após Artroplastia Total da Anca ­ Revisão Sistemática da Literatura", através de uma revisão sistemática da literatura com caráter descritivo exploratório, pela análise de bases de dados científicas e posteriormente, com a aplicação da estratégia PICO, seguindo o Protocolo da Revisão Sistemática da Literatura publicado pela Cochrane, apresentar e descrever os resultados obtidos. A questão "Quais os ganhos em saúde decorrentes da intervenção do enfermeiro de reabilitação após Artroplastia Total da Anca?" foi claramente respondida, concluindo-se que as intervenções passam essencialmente pela reabilitação do paciente, utilizando para o efeito estratégias e técnicas específicas e altamente qualificadas do Enfermeiro de Reabilitação em conjunto com equipa multidisciplinar que acompanha todos os procedimentos no pós-operatório. De facto, os estudos identificados apresentam, na sua maioria, resultados que comprovam a necessidade de implementação de protocolos multidisciplinares de enfermagem de reabilitação, concluindo-se ainda que a avaliação funcional é essencial para determinar o potencial de reabilitação, implementando técnicas de reeducação funcional, planificando a alta clínica e reinserção na comunidade, com o objetivo de prevenir novas fraturas. No decurso da investigação foram analisados, selecionados e avaliados diversos artigos de investigação, sendo considerados válidos para a presente temática dezoito, sendo nove em língua inglesa e nove em língua portuguesa, publicados nos últimos dez anos e de acesso integral, livre e gratuito. Neste sentido os artigos selecionados e considerados válidos indicam claramente a importância do Enfermeiro de Reabilitação, enquanto contributo direto para uma alta bem-sucedida, particularmente, quando associada a sua intervenção a equipas multidisciplinares, contribuindo diretamente para ganhos globais na saúde e reabilitação de pacientes submetidos a artroplastia total da anca.

The present work deals with the theme "Rehabilitation Nursing Intervention after Total Hip Arthroplasty - Systematic Literature Review", through a systematic literature review with an exploratory descriptive character, through the analysis of scientific databases and later, with the application of the PICO strategy, following the Protocol of Systematic Literature Review published by Cochrane, present and describe the results obtained. The question "What are the health gains resulting from the intervention of the rehabilitation nurse after Total Hip Arthroplasty?" it was clearly answered, concluding that the interventions essentially go through the rehabilitation of the patient, using specific and highly qualified strategies and techniques of the Rehabilitation Nurse in conjunction with a multidisciplinary team that monitors all procedures in the postoperative period. In fact, the studies identified present, for the most part, results that prove the need to implement multidisciplinary rehabilitation nursing protocols, concluding that functional assessment is essential to determine the potential for rehabilitation, implementing functional reeducation techniques, planning hospital discharge and reintegration into the community, with the aim of preventing new fractures. In the course of the investigation, several research articles were analyzed, selected and evaluated, being considered valid for the present topic eighteen, nine in English and nine in Portuguese, published in the last ten years and with full, free and free access. In this sense, the articles selected and considered valid clearly indicate the importance of the Rehabilitation Nurse, as a direct contribution to a successful discharge, particularly when associated with its intervention to multidisciplinary teams, contributing directly to global gains in health and rehabilitation of patients submitted total hip arthroplasty.

Simultaneous and direct determination of glyphosate and AMPA in water samples from the hydroponic cultivation of eucalyptus seedlings using HPLC-ICP-MS/MS.

Glyphosate is the main herbicide currently used in the world due to wide applicability and efficiency in controlling weeds in many crops. However, its overuse may lead to undesirable impacts on the environment and to human health in the long run. This present study aimed to optimize and validate solid phase extraction (SPE) using an anionic resin for the simultaneous and direct determination of glyphosate and aminomethylphosphonic acid (AMPA) in water samples using high-performance liquid chromatography combined with inductively coupled plasma with triple quadrupole mass spectrometer (HPLC-ICP-MS/MS). The results showed that recovery percentage and relative standard deviation were 103.9 ± 7.9 and 99.40 ± 9.9% for glyphosate and AMPA, respectively. The validation certified that the method was precise, accurate, linear, and selective, with a limit of quantification of 1.09 and 0.29 µg L-1 for glyphosate and AMPA, respectively. The optimized methodology reached the concentration factor of 250 times and was successfully applied to analyze water samples from hydroponic cultivation of the eucalyptus seedlings. The results showed that the exudation process occurs at glyphosate doses starting from 2 L ha-1.

A pessoa em processo de desmame ventilatório: intervenções do enfermeiro especialista em enfermagem de reabilitação / The person in the process of ventilatory weaning: interventions of the nurse specialist in rehabilitation nursing

As complicações decorrentes da ventilação mecânica invasiva a que, frequentemente, o doente crítico está sujeito tem contribuído significativamente para a redução da sua qualidade de vida, declínio da sua capacidade funcional, aumento dos custos hospitalares, aumento da taxa de mortalidade e necessidades aumentadas de reabilitação, mesmo no período após a alta hospitalar. Estudos recentes, sobre as suas consequências a longo prazo, têm demonstrado que um número significativo de doentes que sobrevivem à doença crítica apresentam um conjunto de morbilidades significativas. Torna-se premente a definição e implementação de intervenções que permitam abreviar o tempo de ventilação mecânica invasiva, minimizando e/ou evitando as suas consequências. Desta forma, o Enfermeiro Especialista em Enfermagem de Reabilitação, surge como um relevante dinamizador, estabelecendo intervenções que consistem em planos individuais e multifacetados e que englobam de forma dinâmica as complexas consequências respiratórias e neuromusculares da doença critica. Este detém autonomia e capacidade para intervir, permitindo que a pessoa em processo de desmame ventilatório ultrapasse esta fase crítica na melhor condição possível, tornando o processo de desmame mais célere e melhorando a capacidade residual e funcional. Neste processo de gestão da doença, a intervenção terapêutica do enfermeiro, surge na substituição da pessoa incapaz de o garantir, potenciando a sua autonomia e independência. A conceptualização da resposta a esta problemática baseou-se na Teoria do Défice de Autocuidado de Dorothea Orem e com o desenvolvimento de competências de enfermagem de reabilitação através de uma revisão scoping que que sustentou uma prática reflexiva. No presente relatório evidenciam-se as competências desenvolvidas como Enfermeiro Especialista em Enfermagem de Reabilitação. Para tal, foi desenvolvido estágio em dois contextos distintos, Unidade de Cuidados Intensivos Respiratórios e Equipa de Cuidados Continuados e ambos na região de Lisboa, tendo como ponto de partida o planeado anteriormente.

Complications due to invasive mechanical ventilation to which critically ill patients are often subjected have significantly contributed to reduced quality of life, declining functional capacity, increased hospital costs, increased mortality rate and increased rehabilitation needs. even in the period after hospital discharge. Recent studies on its long-term consequences have shown that a significant number of patients surviving critical illness have a significant set of morbidities. The definition and implementation of interventions that shorten the invasive mechanical ventilation time, minimizing and / or avoiding its consequences, is urgent. Thus, the Rehabilitation Nursing Specialist Nurse emerges as a relevant driver, establishing interventions that consist of individual and multifaceted plans and that dynamically encompass the complex respiratory and neuromuscular consequences of critical illness. It has the autonomy and ability to intervene, allowing the person undergoing ventilatory weaning to overcome this critical phase in the best possible condition, making the weaning process faster and improving residual and functional capacity. In this process of disease management, the therapeutic intervention of nurses arises in the substitution of the person unable to guarantee it, enhancing their autonomy and independence. The conceptualization of the response to this problem was based on Dorothea Orem's Self-Care Deficit Theory and the development of rehabilitation nursing skills through a scoping review that sustained a reflective practice. This report highlights the skills developed as a Specialist Nurse in Rehabilitation Nursing. To this end, internships were developed in two different contexts, the Respiratory Intensive Care Unit and the Continuing Care Team and both in the Lisbon region, based on the previously planned starting point.

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest.

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events.

Clinical, morphogical and immunohistochemical aspects of oral inflammatory myofibroblastic tumor: a rare case report in a pediatric patient / Aspectos clínicos, morfológicos e imuno-histoquímicos do tumor miofibroblástico inflamatório oral: relato de caso raro em paciente pediátrico / Aspectos clínicos, morfológicos e inmuno-histoquímicos del tumor miofibroblástico inflamatorio oral: reporte de caso raro en paciente pediátrico

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm composed by myofibroblasts and fibroblasts admixed with inflammatory cells. Here, we report a case of IMT in the oral cavity of left mandible of a 12-year-old boy. Histopathological investigation revealed a proliferation of fibroblasts and myofibroblasts (positive for alpha-smooth muscle actin and vimentin) associated with inflammatory cells. The patient is still under follow-up and without evidence of recurrence. Oral IMT is a challenge for the clinician in diagnosis due to the nonspecific clinical presentation. Thus, histology and immunohistochemistry are required to reach an accurate diagnosis of this lesion(AU)

O tumor miofibroblástico inflamatório (TMI) é uma neoplasia benigna rara composta por miofibroblastos e fibroblastos associados com células inflamatórias. Aqui, relatamos um caso de TMI na cavidade oral da mandíbula esquerda de um menino de 12 anos. A análise histopatológica revelou uma proliferação de fibroblastos e miofibroblastos (positivos para alfa-actina de músculo liso e vimentina) associados à células inflamatórias. O paciente ainda está sob acompanhamento e sem evidências de recorrência. O TMI oral é um desafio diagnóstico para o clínico devido à apresentação clínica não específica. Assim, análises histopatológicas e imuno-histoquímicas são necessárias para alcançar um diagnóstico preciso dessa lesão(AU)

El tumor miofibroblástico inflamatorio (TMI) es una neoplasia benigna rara compuesta de miofibroblastos y fibroblastos asociados con células inflamatorias. Aquí, relatamos un caso de TMI en la cavidad oral de la mandíbula izquierda de un niño de 12 años. El análisis histopatológico reveló una proliferación de fibroblastos y miofibroblastos (positivos para alfa-actina de músculo liso y vimentina) asociados a las células inflamatorias. El paciente todavía está bajo seguimiento y sin evidencias de recurrencia. El TMI oral es un desafío diagnóstico para el clínico debido a la presentación clínica no específica. Así, los análisis histopatológicos e inmuno-histoquímicos son necesarios para alcanzar un diagnóstico preciso de esa lesión(AU)

Clinicopathological study of oral focal mucinosis: a retrospective case series

Background: Oral focal mucinosis (OFM) is a rare soft tissue lesion of unknown etiology that exhibits tumor-like growth. It is considered the oral counterpart of cutaneous focal mucinosis or cutaneous myxoid cyst. This is a retrospective study of oral OFM diagnosed over a period of 42 years at an oral pathology service. Material and Methods: Clinical, histopathological and immunohistochemical data were analyzed. Alcian blue staining and S-100 immunohistochemistry were performed. Results: Eleven cases were retrieved (4:1 female-to-male ratio). The mean age was 44 years. The gingiva was the most affected site. The main clinical presentation was sessile or pedunculated lesions of fibrous or hyperplasic appearance, most of them asymptomatic. Positive Alcian blue staining and absence of S-100 protein were observed in all specimens, which supported the histological diagnosis of OFM. Surgical excision was the treatment of choice. Conclusions: Although rare, this study supports the inclusion of OFM in the differential diagnosis of intraoral myxoid lesions

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Vesículas extracelulares derivadas de macrófagos alteram o potencial de invasão, proliferação e migração de linhagens celulares do carcinoma de células escamosas de língua oral / Macrophage-derived extracellular vesicles alter the potential for invasion, proliferation, and migration of oral tongue squamous cell carcinoma cell lines

O câncer é composto pelas células malignas em proliferação associadas às diferentes células circunjacentes, formando o microambiente tumoral (TME), onde há uma constante troca de informações. Uma das formas de comunicação entre os diferentes tipos celulares do TME se dá por meio da liberação de vesículas extracelulares (EVs), um campo de estudo ainda pouco explorado. O presente estudo se propôs a avaliar os efeitos das EVs liberadas por macrófagos do TME, células altamente plásticas em seu fenótipo (M1 ­ perfil antitumoral; M2 ­ perfil pró-tumoral), em diferentes linhagens do carcinoma de células escamosas de língua oral (CCELO) no tocante à capacidade invasiva, proliferativa e migratória. Foi observado que as amostras de EVs extraídas dos macrófagos eram relativamente puras em EVs, porém subtipo inespecíficas. No ensaio de invasão em miomas, quando colocadas as células inflamatórias em cocultura com as células HSC-3, as células M1 inibiram a invasão e M2 aumentaram a capacidade invasiva das células malignas. Por outro lado, o tratamento com M1 EVs aumentou a capacidade invasiva das células HSC-3 e o tratamento com EVs de M2 inibiu a invasão dessas células, sendo observado um perfil semelhante nas células SCC-25 e SAS quando submetidas aos mesmos tratamentos. Na análise do marcador Ki-67 nos miomas, tanto as células HSC-3 quanto SCC-25 e SAS apresentaram o mesmo padrão de proliferação independentemente do tratamento utilizado, quando comparados com os respectivos controles negativos. Quando analisada a proliferação das células malignas no IncuCyte®, tratadas com EVs dos diferentes tipos de macrófagos em diferentes concentrações, foi identificado um aumento na capacidade proliferativa de células HSC-3 e SAS tratadas com M1 EVs em um padrão dose dependente. Um aumento da capacidade proliferativa seguindo um padrão dose dependente também ocorreu quando as células SAS foram tratadas com M2 EVs. Nos demais ensaios de proliferação no IncuCyte® também foram identificados efeitos na capacidade proliferativa, no entanto um padrão dose dependente não foi observado. No ensaio de migração no IncuCyte®, foram identificadas diferenças significativas na capacidade migratória de células SCC-25 e SAS tratadas com diferentes tipos de EVs nas diferentes concentrações, quando comparadas ao controle negativo. Os achados deste estudo sugerem que as EVs derivadas de macrófagos são fatores importantes na tumorigênese do CCELO, bem como abre discussões sobre os diferentes efeitos das células inflamatórias no TME a depender do tipo de comunicação celular executada (AU).

Cancer is an entity composed of proliferating malignant cells associated with the different types surrounding cells, forming the tumor microenvironment (TME), where there is a constant exchange of information. One of the ways of communicating between different types of TME cells is through the release of extracellular vesicles (EVs), a field of study that remains poorly understood. The aim of the present study was to evaluate the effects of EVs released from TME macrophages, which are cells highly plastic in their phenotype (M1 showing an anti-tumor profile and M2 exhibiting a pro-tumor profile) in different cell lines of tongue squamous cells carcinoma (TSCC) regarding to invasive, proliferative and migratory capacity. It was observed that EVs samples obtained from macrophages were relatively pure in EVs, although they were non-specific subtypes. In the myoma invasion assay, it was observed that when inflammatory cells were co-cultured with HSC-3 cells, M1 cells inhibited invasion and M2 increased the invasive ability of the malignant cells. On the other hand, treatment with M1 EVs increased the invasive capacity of HSC-3 cells, and treatment with M2 EVs inhibited the invasion of these malignant cells, and a similar profile was observed in SCC-25 and SAS cells when they were submitted to the same treatments. In the analysis of the Ki-67 marker in myomas, HSC-3, SCC-25 and SAS cells showed the same proliferation pattern regardless the type of the treatment used when compared to the respective negative controls. When it was analyzed the proliferation of malignant cells in IncuCyte® treated with EVs derived from different types of macrophages at different concentrations, an increase in the proliferative ability of HSC-3 and SAS cells treated with M1 EVs was observed in a dosedependent pattern. An increase in proliferative ability in dose-dependent profile was also observed when SAS cells were treated with M2 EVs. In the other proliferation assays performed in IncuCyte®, effects on proliferative capacity were also highlighted, however a dose-dependent pattern was not observed. In the IncuCyte® migration assay, significant differences were observed in the migration capacity of SCC-25 and SAS cells treated with different types of EVs at different concentrations when compared to the negative control. The findings of this study suggest that macrophages-derived EVs are pivotal factors in TSCC tumorigenesis, as well as permits discussions on the different effects of inflammatory cells on TME depending on the type of cell communication performed (AU).

An update of 77 cases diagnosed as oral hemangiomas based on GLUT-1 positivity.

OBJECTIVES: To evaluate cases diagnosed as "oral hemangiomas" based on the immunohistochemical expression of human glucose transporter protein (GLUT-1) and on histopathological features, and to investigate whether the classification proposed by the ISSVA was used correctly to classify these lesions. MATERIAL AND METHODS: All cases stored in the archives of an Oral Pathology Service and diagnosed as "oral hemangiomas" were reviewed. Seventy-seven cases were analyzed regarding the expression of GLUT-1. GLUT-1(+) specimens were classified as true infantile hemangioma (IH) and GLUT-1(-) specimens were reclassified based on their histopathological features. The nomenclature of these lesions was evaluated and some cases were reclassified. RESULTS: Only 26 (33.8%) of the specimens were indeed IHs. Among the GLUT-1(-) specimens, 20 (26.0%) were reclassified as pyogenic granulomas (PGs) and 31 (40.2%) as vascular malformations. Considering the previously applied nomenclature, only 47.5% of the cases initially diagnosed as "hemangiomas" were IHs. In the group of "capillary hemangiomas", most cases (56.2%) were PGs. Among the three "cellular hemangiomas", two were PGs and one was IH. Most (88.8%) "cavernous hemangiomas" were vascular malformations. CONCLUSION: Careful and parameterized review of cases of vascular anomalies is necessary using auxiliary tools such as GLUT-1, since the exclusive use of histopathological findings might be insufficient to differentiate some anomalies. CLINICAL RELEVANCE: Accurate clinical examination and the use of biomarkers such as GLUT-1 are essential for the diagnosis.

Osteoblastoma in the retromolar region: a case report / Osteoblastoma em região retromolar: relato de caso

ABSTRACT Osteoblastoma is a rare benign tumor that accounts for less than 1% of all bone tumors. About 10% of osteoblastomas are found in the skull bones and almost half of these cases involve the mandible, especially the posterior segments. This report describes the case of a 27-year-old female patient with a unilocular radiopaque expansive lesion in the left mandible, which had well-delimited margins and caused mild bone expansion. Microscopic analysis revealed the presence of mineralized material in the form of irregularly arranged vital trabeculae at different stages of mineralization. Osteocytes were trapped inside these trabeculae, which contained osteoclast-like multinucleated cells and voluminous pavement cells with hyperchromatic nuclei, sometimes interpreted as osteoblasts. Many bone-producing lesions have clinical, radiologic and histopathologic features that resemble osteoblastoma. The understanding and correlation of these findings are extremely important since they contribute to the correct diagnosis and appropriate treatment of this rare entity, improving its prognosis.

RESUMO Osteoblastoma é um tumor benigno raro que representa menos de 1% de todos os tumores ósseos e 10% estão localizadas nos ossos do crânio e quase metade destes casos afeta a mandíbula, especialmente os segmentos posteriores. Este relato descreve um caso de uma lesão radiopaca unilocular expansiva na mandíbula esquerda, com margens bem delimitadas, causando expansão discreta do osso em um paciente do sexo feminino de 27 anos de idade. O exame microscópico revelou presença de material mineralizado na forma de trabéculas vitais com diferentes estágios de mineralização dispostas irregularmente e exibindo osteócitos aprisionados em seu interior, células multinucleadas semelhantes a osteoclastos e pavimentação células volumosas que têm núcleos hipercromáticos, por vezes interpretados como osteoblastos. Muitas lesões produtoras de osso possuem características clínicas, radiológicas ou histopatológicas semelhantes ao osteoblastoma. Compreender e correlacionar todos esses achados é de extrema importância, uma vez que auxilia no correto diagnóstico adequado tratamento desta entidade rara, levando a um bom prognóstico.

Improving Heat Transfer at the Bottom of Vials for Consistent Freeze Drying with Unidirectional Structured Ice.

The quality of lyophilized products is dependent of the ice structure formed during the freezing step. Herein, we evaluate the importance of the air gap at the bottom of lyophilization vials for consistent nucleation, ice structure, and cake appearance. The bottom of lyophilization vials was modified by attaching a rectified aluminum disc with an adhesive material. Freezing was studied for normal and converted vials, with different volumes of solution, varying initial solution temperature (from 5°C to 20°C) and shelf temperature (from -20°C to -40°C). The impact of the air gap on the overall heat transfer was interpreted with the assistance of a computational fluid dynamics model. Converted vials caused nucleation at the bottom and decreased the nucleation time up to one order of magnitude. The formation of ice crystals unidirectionally structured from bottom to top lead to a honeycomb-structured cake after lyophilization of a solution with 4% mannitol. The primary drying time was reduced by approximately 35%. Converted vials that were frozen radially instead of bottom-up showed similar improvements compared with normal vials but very poor cake quality. Overall, the curvature of the bottom of glass vials presents a considerable threat to consistency by delaying nucleation and causing radial ice growth. Rectifying the vials bottom with an adhesive material revealed to be a relatively simple alternative to overcome this inconsistency.

Importance of GLUT1 in differential diagnosis of vascular anomalies / Importância da GLUT1 no diagnóstico diferencial das anomalias vasculares

Vascular anomalies (VAs) include a group of distinct lesions, such as vascular system congenital malformations, as well as benign and malignant vascular tumors. These lesions may present similar clinical and histopathological features, leading to mistaken diagnoses and incorrect treatment choices. It is important that professionals responsible for monitoring the development of VAs conduct precise investigations and use the appropriate terminology. The human glucose transporter protein isoform 1 (GLUT1) has been proposed as a tool to aid in differential diagnosis between different VAs, given that it is a sensitive and specific marker for identification of infantile hemangiomas (HIs) in any organ. This article presents a review of the literature on this protein as an effective tool for identification and possible differential diagnosis between several VAs.

As anomalias vasculares (AVs) incluem um grupo de lesões distintas, como as más formações congênitas e os tumores vasculares benignos ou malignos. Estas lesões podem apresentar características clínicas e histopatológicas semelhantes, ocasionando equívocos diagnósticos e terapêuticos. Uma investigação precisa e o uso de terminologia adequada são fundamentais para as decisões do profissional responsável pelo acompanhamento da evolução de uma AV. A isoforma 1 da proteína humana transportadora de glicose (GLUT1) tem sido proposta como uma ferramenta auxiliar para o estabelecimento de diagnóstico diferencial entre AVs, uma vez que representa um marcador sensível e específico para a identificação de hemangiomas da infância de qualquer órgão. Este estudo objetiva fazer uma revisão da literatura acerca desta proteína como ferramenta eficaz na identificação e no possível diagnóstico diferencial entre as diversas AVs.

Respostas de emergência à pessoa em situação crítica nas enfermarias do hospital: As práticas, os resultados e as opiniões dos enfermeiros / Emergency responses to critically ill patients on hospital wards: Nurses' practices, outcomes, and opinions

É consensual que a situação clínica do doente em contexto intra-hospitalar obedece, muitas vezes, a um agravamento progressivo nas horas que antecedem a situação de emergência. Uma intervenção precoce e adequada pode diminuir a mortalidade e a morbilidade destes doentes. Neste sentido, a implementação de Equipas de Emergência Médica Intra-hospitalar torna-se imperativa. Os enfermeiros são o elo fundamental no reconhecimento e deteção de situações que possam comprometer a estabilidade clínica ou até mesmo a vida do doente. O alerta precoce e as intervenções necessárias, devem ter em conta o estado clínico do doente. A ativação da Equipa de Emergência Médica Intra-Hospitalar deve obedecer a critérios padrão e recorrer a sistemas de classificação de doentes que antecipem a falência e previnam a paragem cardio-respiratória. Assim, os objetivos deste estudo são identificar a situação clínica do doente na enfermaria e as intervenções realizadas antes, durante e após a ativação da emergência interna no polo Hospitais da Universidade de Coimbra, e conhecer a opinião dos enfermeiros quanto à sua capacidade de resposta face à pessoa em situação crítica, autoconfiança e recetividade a novas aplicações na área de emergência intra-hospitalar. Trata-se de um estudo de metodologia mista, que compreende informação de natureza quantitativa e qualitativa, através de dois estudos complementares. No estudo I, de caráter exploratório retrospetivo, transversal recorreu-se à análise documental retrospetiva dos processos únicos dos doentes, definindo-se uma amostra aleatória de 60 elementos. No estudo II, do tipo prospetivo, analisou-se a opinião dos enfermeiros das enfermarias, relativa a esta área de intervenção, sendo esta amostra constituída por 245 elementos. Os resultados do estudo I demonstraram através dos dados disponíveis nos registos médicos e de enfermagem, a viabilidade da utilização de escalas de classificação precoce e algoritmos de intervenção para a situação clínica vivenciada pelo doente, assim como, a relevância da ativação precoce da Equipa de Emergência Médica Intra-Hospitalar. No estudo II, a opinião manifestada pelos enfermeiros evidencia níveis tendencialmente baixos de autoconfiança, sentimentos de desamparo e limitação na resposta ao doente em situação crítica, justificadas pela necessidade de enfermeiros com ?mais experiência?, ?maior conhecimento?, ?melhor resposta em paragem cardio-respiratória?, ?metodologia de trabalho comum? e expressando, maioritariamente, a pertinência de integração de um enfermeiro na Equipa de Emergência Médica Intra-Hospitalar e da reestruturação de políticas institucionais neste domínio.

New thermoresistant polymorph from CO2 recrystallization of minocycline hydrochloride.

PURPOSE: To prepare and thoroughly characterize a new polymorph of the broad-spectrum antibiotic minocycline from its hydrochloride dehydrate salts. METHODS: The new minocycline hydrochloride polymorph was prepared by means of the antisolvent effect caused by carbon dioxide. Minocycline recrystallized as a red crystalline hydrochloride salt, starting from solutions or suspensions containing CO2 and ethanol under defined conditions of temperature, pressure and composition. RESULTS: This novel polymorph (ß-minocycline) revealed characteristic PXRD and FTIR patterns and a high melting point (of 247 ºC) compared to the initial minocycline hydrochloride hydrates (α-minocycline). Upon dissolution the new polymorph showed full anti-microbial activity. Solid-state NMR and DSC studies evidenced the higher chemical stability and crystalline homogeneity of ß-minocycline compared to the commercial chlorohydrate powders. Molecular structures of both minocyclines present relevant differences as shown by multinuclear solid-state NMR. CONCLUSIONS: This work describes a new crystalline structure of minocycline and evidences the ability of ethanol-CO2 system in removing water molecules from the crystalline structure of this API, at modest pressure, temperature and relatively short time (2 h), while controlling the crystal habit. This process has therefore the potential to become a consistent alternative towards the control of the solid form of APIs.