Tropical root responses to global changes: A synthesis.

Tropical ecosystems face escalating global change. These shifts can disrupt tropical forests' carbon (C) balance and impact root dynamics. Since roots perform essential functions such as resource acquisition and tissue protection, root responses can inform about the strategies and vulnerabilities of ecosystems facing present and future global changes. However, root trait dynamics are poorly understood, especially in tropical ecosystems. We analyzed existing research on tropical root responses to key global change drivers: warming, drought, flooding, cyclones, nitrogen (N) deposition, elevated (e) CO2, and fires. Based on tree species- and community-level literature, we obtained 266 root trait observations from 93 studies across 24 tropical countries. We found differences in the proportion of root responsiveness to global change among different global change drivers but not among root categories. In particular, we observed that tropical root systems responded to warming and eCO2 by increasing root biomass in species-scale studies. Drought increased the root: shoot ratio with no change in root biomass, indicating a decline in aboveground biomass. Despite N deposition being the most studied global change driver, it had some of the most variable effects on root characteristics, with few predictable responses. Episodic disturbances such as cyclones, fires, and flooding consistently resulted in a change in root trait expressions, with cyclones and fires increasing root production, potentially due to shifts in plant community and nutrient inputs, while flooding changed plant regulatory metabolisms due to low oxygen conditions. The data available to date clearly show that tropical forest root characteristics and dynamics are responding to global change, although in ways that are not always predictable. This synthesis indicates the need for replicated studies across root characteristics at species and community scales under different global change factors.

Toward a coordinated understanding of hydro-biogeochemical root functions in tropical forests for application in vegetation models.

Tropical forest root characteristics and resource acquisition strategies are underrepresented in vegetation and global models, hampering the prediction of forest-climate feedbacks for these carbon-rich ecosystems. Lowland tropical forests often have globally unique combinations of high taxonomic and functional biodiversity, rainfall seasonality, and strongly weathered infertile soils, giving rise to distinct patterns in root traits and functions compared with higher latitude ecosystems. We provide a roadmap for integrating recent advances in our understanding of tropical forest belowground function into vegetation models, focusing on water and nutrient acquisition. We offer comparisons of recent advances in empirical and model understanding of root characteristics that represent important functional processes in tropical forests. We focus on: (1) fine-root strategies for soil resource exploration, (2) coupling and trade-offs in fine-root water vs nutrient acquisition, and (3) aboveground-belowground linkages in plant resource acquisition and use. We suggest avenues for representing these extremely diverse plant communities in computationally manageable and ecologically meaningful groups in models for linked aboveground-belowground hydro-nutrient functions. Tropical forests are undergoing warming, shifting rainfall regimes, and exacerbation of soil nutrient scarcity caused by elevated atmospheric CO2. The accurate model representation of tropical forest functions is crucial for understanding the interactions of this biome with the climate.

Las características de las raíces de los bosques tropicales y las estrategias de adquisición de recursos están subrepresentadas en modelos de vegetación, lo que dificulta la predicción del efecto de cambio de clima para estos ecosistemas ricos en carbono. Los bosques tropicales a menudo tienen combinaciones únicas a nivel mundial de alta biodiversidad taxonómica y funcional, estacionalidad de precipitación, y suelos infértiles, dando lugar a patrones distintos en los rasgos y funciones de las raíces en comparación con los ecosistemas de latitudes más altas. Integramos los avances recientes en nuestra comprensión de la función subterránea de los bosques tropicales en modelos de vegetación, centrándonos en la adquisición de agua y nutrientes. Ofrecemos comparaciones de avances recientes en la comprensión empírica y de modelos de las características de las raíces que representan procesos funcionales importantes en los bosques tropicales. Nos centramos en: (1) estrategias de raíces finas para adquisición de recursos del suelo, (2) acoplamiento y compensaciones entre adquisición del agua y de nutrientes, y (3) vínculos entre funciones sobre tierra y debajo del superficie en bosques tropicales. Sugerimos vías para representar estas comunidades de plantas extremadamente diversas en grupos computacionalmente manejables y ecológicamente significativos en modelos. Los bosques tropicales se están calentando, tienen cambios en los regímenes de lluvias, y tienen una exacerbación de la escasez de nutrientes del suelo causada por el elevado CO2 atmosférico. La representación precisa de las funciones de los bosques tropicales en modelos es crucial para comprender las interacciones de este bioma con el clima.

Dimensions of good palliative nursing care: Expert panel consensus and perceptions of palliative professionals.

AIMS AND OBJECTIVES: To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale. BACKGROUND: The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are. DESIGN: Mixed-method, Delphi approach and exploratory qualitative study. METHODS: Consensus by a panel of experts using the Delphi technique and semi-structured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018. RESULTS: The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element. CONCLUSIONS: The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family. RELEVANCE TO CLINICAL PRACTICE: Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses. PATIENT OR PUBLIC CONTRIBUTION: Two primary caregivers participated in the panel of experts and the semi-structured interview.

Below-ground traits mediate tree survival in a tropical dry forest restoration.

Reforestation is one of our most promising natural climate solutions, and one that addresses the looming biodiversity crisis. Tree planting can catalyse forest community reassembly in degraded landscapes where natural regeneration is slow, however, tree survival rates vary remarkably across projects. Building a trait-based framework for tree survival could streamline species selection in a way that generalizes across ecosystems, thereby increasing the effectiveness of the global restoration movement. We investigated how traits mediated seedling survival in a tropical dry forest restoration, and how traits were coordinated across plant structures. We examined growth and survival of 14 species for 2 years and measured six below-ground and 22 above-ground traits. Species-level survival ranged widely from 7.8% to 90.1%, and a model including growth rate, below-ground traits and their interaction explained more than 73% of this variation. A strong interaction between below-ground traits and growth rate indicated that selecting species with fast growth rates can promote establishment, but this effect was most apparent for species that invest in thick fine roots and deep root structures. Overall, results emphasize the prominent role of below-ground traits in determining early restoration outcomes, and highlight little above- and below-ground trait coordination, providing a path forward for tropical dry forest restoration efforts. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.

Phosphorus limitation of early growth differs between nitrogen-fixing and nonfixing dry tropical forest tree species.

Tropical forests are often characterized by low soil phosphorus (P) availability, suggesting that P limits plant performance. However, how seedlings from different functional types respond to soil P availability is poorly known but important for understanding and modeling forest dynamics under changing environmental conditions. We grew four nitrogen (N)-fixing Fabaceae and seven diverse non-N-fixing tropical dry forest tree species in a shade house under three P fertilization treatments and evaluated carbon (C) allocation responses, P demand, P-use, investment in P acquisition traits, and correlations among P acquisition traits. Nitrogen fixers grew larger with increasing P addition in contrast to non-N fixers, which showed fewer responses in C allocation and P use. Foliar P increased with P addition for both functional types, while P acquisition strategies did not vary among treatments but differed between functional types, with N fixers showing higher root phosphatase activity (RPA) than nonfixers. Growth responses suggest that N fixers are limited by P, but nonfixers may be limited by other resources. However, regardless of limitation, P acquisition traits such as mycorrhizal colonization and RPA were nonplastic across a steep P gradient. Differential limitation among plant functional types has implications for forest succession and earth system models.

Leaf habit affects the distribution of drought sensitivity but not water transport efficiency in the tropics.

Considering the global intensification of aridity in tropical biomes due to climate change, we need to understand what shapes the distribution of drought sensitivity in tropical plants. We conducted a pantropical data synthesis representing 1117 species to test whether xylem-specific hydraulic conductivity (KS ), water potential at leaf turgor loss (ΨTLP ) and water potential at 50% loss of KS (ΨP50 ) varied along climate gradients. The ΨTLP and ΨP50 increased with climatic moisture only for evergreen species, but KS did not. Species with high ΨTLP and ΨP50 values were associated with both dry and wet environments. However, drought-deciduous species showed high ΨTLP and ΨP50 values regardless of water availability, whereas evergreen species only in wet environments. All three traits showed a weak phylogenetic signal and a short half-life. These results suggest strong environmental controls on trait variance, which in turn is modulated by leaf habit along climatic moisture gradients in the tropics.

Quality of palliative nursing care: Meaning, death anxiety, and the mediating role of well-being.

BACKGROUND: There is increasing concern regarding the quality of palliative nursing care. However, despite the growing number of studies identifying related variables, there is still a paucity of studies analyzing models of how these variables interrelate. OBJECTIVE: The study aimed to identify the role played in the quality of palliative care of nursing professionals by the variables meaning and death anxiety and to investigate the mediating role of psychological well-being and engagement. METHOD: 176 palliative nursing professionals participated, selected by non-probabilistic convenience sampling using the snowball method. A simple mediation analysis and a multiple mediator model were performed in parallel, and data were collected using a paper and online questionnaire between January and May 2018. RESULTS: Well-being mediated the impact of meaning (indirect effect = 0.096, SE = 0.044, 95% confidence interval (CI): 0.028, 0.213) and death anxiety (indirect effect = -0.032, SE = 0.013, 95% CI: -0.064, -0.010) on the quality of care. Engagement, on the other hand, only mediated the impact of meaning (indirect effect = 0.185, SE = 0.085, 95% CI: 0.035, 0.372), while the indirect effect of death anxiety with the quality of care through engagement was not statistically significant (indirect effect = 0.008, SE = 0.009, 95% CI: -0.004, 0.032). SIGNIFICANCE OF RESULTS: Death anxiety is not directly related to the quality of care, but rather has an effect through psychological well-being, a variable acting as a mediator between the two. The effect of meaning on the quality of care is explained by the mediation of both engagement and psychological well-being, and its impact on the quality of care is thereby mediated by more variables than death anxiety.

Autophagy, TERT, and mitochondrial dysfunction in hyperoxia.

Ventilation with gases containing enhanced fractions of oxygen is the cornerstone of therapy for patients with hypoxia and acute respiratory distress syndrome. Yet, hyperoxia treatment increases free reactive oxygen species (ROS)-induced lung injury, which is reported to disrupt autophagy/mitophagy. Altered extranuclear activity of the catalytic subunit of telomerase, telomerase reverse transcriptase (TERT), plays a protective role in ROS injury and autophagy in the systemic and coronary endothelium. We investigated interactions between autophagy/mitophagy and TERT that contribute to mitochondrial dysfunction and pulmonary injury in cultured rat lung microvascular endothelial cells (RLMVECs) exposed in vitro, and rat lungs exposed in vivo to hyperoxia for 48 h. Hyperoxia-induced mitochondrial damage in rat lungs [TOMM20, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)], which was paralleled by increased markers of inflammation [myeloperoxidase (MPO), IL-1ß, TLR9], impaired autophagy signaling (Beclin-1, LC3B-II/1, and p62), and decreased the expression of TERT. Mitochondrial-specific autophagy (mitophagy) was not altered, as hyperoxia increased expression of Pink1 but not Parkin. Hyperoxia-induced mitochondrial damage (TOMM20) was more pronounced in rats that lack the catalytic subunit of TERT and resulted in a reduction in cellular proliferation rather than cell death in RLMVECs. Activation of TERT or autophagy individually offset mitochondrial damage (MTT). Combined activation/inhibition failed to alleviate hyperoxic-induced mitochondrial damage in vitro, whereas activation of autophagy in vivo decreased mitochondrial damage (MTT) in both wild type (WT) and rats lacking TERT. Functionally, activation of either TERT or autophagy preserved transendothelial membrane resistance. Altogether, these observations show that activation of autophagy/mitophagy and/or TERT mitigate loss of mitochondrial function and barrier integrity in hyperoxia.NEW & NOTEWORTHY In cultured pulmonary artery endothelial cells and in lungs exposed in vivo to hyperoxia, autophagy is activated, but clearance of autophagosomes is impaired in a manner that suggests cross talk between TERT and autophagy. Stimulation of autophagy prevents hyperoxia-induced decreases in mitochondrial metabolism and sustains monolayer resistance. Hyperoxia increases mitochondrial outer membrane (TOMM20) protein, decreases mitochondrial function, and reduces cellular proliferation without increasing cell death.

Trait mindfulness, rumination, and well-being in family caregivers of people with acquired brain injury / Mindfulness como rasgo, la rumiación y el bienestar en los cuidadores de las personas con daño cerebral adquirido

This study examined the relationship between trait mindfulness, rumination, quality of life, anxiety, and depression in family caregivers of people with Acquired Brain Injury (ABI). Participants were 78 caregivers (75.6% women) aged between 22 and 80 years. The participants completed measures of behavioral and emotional problems in the person with ABI, trait mindfulness, symptoms of anxiety and depression, quality of life, and rumination. The results showed that mindfulness is associated with fewer symptoms of anxiety and depression and better quality of life, and that this is explained through less use of rumination. Likewise, behavioral and emotional problems of the person with ABI were associated with more depression and lower quality of life in the caregiver. Rumination explained part of this association. Finally, behavioral and emotional problems of the person with ABI were more strongly associated with depression in caregivers with low trait mindfulness. (AU)

Este estudio examinó la relación entre el rasgo de mindfulness, rumiación, calidad de vida, ansiedad y depresión en cuidadores de personas con daño cerebral adquirido (DCA). Participaron 78 cuidadores (75.6% mujeres) de edades comprendidas entre 22 y 80 años. Los participantes facilitaron medidas de problemas conductuales y emocionales de la persona con DCA, rasgo de mindfulness, síntomas de ansiedad y depresión, calidad de vida y rumiación. Los resultados mostraron que mindfulness se asocia a menos síntomas de ansiedad y depresión y más calidad de vida y que esto se explica a través de un menor uso de la rumiación. Asimismo, los problemas conductuales y emocionales de la persona con DCA se asocian a una mayor depresión y menor calidad de vida en el cuidador. La rumiación media parte de esta asociación. Finalmente, los problemas conductuales y emocionales de la persona con DCA se asocian más estrechamente a la depresión en los cuidadores con bajo nivel de mindfulness. (AU)

H1 histones control the epigenetic landscape by local chromatin compaction.

H1 linker histones are the most abundant chromatin-binding proteins1. In vitro studies indicate that their association with chromatin determines nucleosome spacing and enables arrays of nucleosomes to fold into more compact chromatin structures. However, the in vivo roles of H1 are poorly understood2. Here we show that the local density of H1 controls the balance of repressive and active chromatin domains by promoting genomic compaction. We generated a conditional triple-H1-knockout mouse strain and depleted H1 in haematopoietic cells. H1 depletion in T cells leads to de-repression of T cell activation genes, a process that mimics normal T cell activation. Comparison of chromatin structure in normal and H1-depleted CD8+ T cells reveals that H1-mediated chromatin compaction occurs primarily in regions of the genome containing higher than average levels of H1: the chromosome conformation capture (Hi-C) B compartment and regions of the Hi-C A compartment marked by PRC2. Reduction of H1 stoichiometry leads to decreased H3K27 methylation, increased H3K36 methylation, B-to-A-compartment shifting and an increase in interaction frequency between compartments. In vitro, H1 promotes PRC2-mediated H3K27 methylation and inhibits NSD2-mediated H3K36 methylation. Mechanistically, H1 mediates these opposite effects by promoting physical compaction of the chromatin substrate. Our results establish H1 as a critical regulator of gene silencing through localized control of chromatin compaction, 3D genome organization and the epigenetic landscape.

[Panniculitis in association with target therapy in melanoma patient, what the dermatologist should know: A case report]. / Paniculitis secundaria a terapia target en paciente con melanoma, lo que el dermatólogo debe saber: reporte de un caso.

Target therapies are currently a therapeutic option increasingly used for the management of patients with metastatic melanoma. However, there are multiple adverse pharmacological effects associated with their use that have been described. Cutaneous adverse reactions are the most frequent. We report the case of a 55-year-old man with a diagnosis of stage IV BRAFV600E-mutated metastatic cutaneous melanoma undergoing treatment with dabrafenib/trametinib, who consulted due to the development of erythematous nodular lesions in the upper and lower limbs associated with febrile sensation during the course of treatment. Infection was ruled out and a biopsy of the skin lesions was done, which provided the histopathological confirmation of a predominantly septal, granulomatous with leukocytoclastic vasculitis, mixed panniculitis. Panniculitis associated with this therapy has been described in the literature and has been considered an immune-mediated pharmacological adverse effect. It is considered to be related to a better prognosis in the treatment of metastatic melanoma. Consequently, as shown in this case report, target therapy should not be discontinued and symptomatic medication should be given to alleviate patient discomfort. The dermatologist should know and properly interpret this adverse effect and prescribe the most appropriate management for the patient.

Las terapias target constituyen hoy en día una alternativa terapéutica cada vez más utilizada para el manejo de pacientes con melanoma metastásico. Sin embargo, se han descrito múltiples efectos farmacológicos adversos asociados a su uso, siendo los cutáneos los de mayor prevalencia. Se presenta el caso de un hombre de 55 años con diagnóstico de melanoma cutáneo metastásico etapa IV, BRAFV600E mutado, en tratamiento con dabrafenib/trametinib que consultó por desarrollo de lesiones nodulares eritematosas sensibles en extremidades superiores e inferiores, asociadas a sensación febril durante el curso del tratamiento. Se descartó alguna infección sobreagregada. Se realizó una biopsia de las lesiones cutáneas, con confirmación diagnóstica histopatológica de una paniculitis mixta de predominio septal, granulomatosa y con vasculitis leucocitoclástica. La paniculitis asociada a esta terapia ha sido descrita en la literatura y se ha considerado un efecto farmacológico inmunomediado adverso, relacionándose a un mejor pronóstico para el melanoma metastásico en tratamiento. Por lo tanto, así como en el caso presentado, se evita la suspensión del fármaco y se asocia terapia sintomática en caso de mayores molestias del paciente. Es de alta relevancia para el dermatólogo conocer e interpretar adecuadamente este efecto adverso farmacológico, y así indicar el manejo más adecuado para el paciente.

Good palliative nursing care: Design and validation of the palliative nursing care quality scale (PNCQS).

AIMS: Develop and psychometrically assess the Palliative Nursing Care Quality Scale (PNCQS, escala de Calidad del Cuidado Enfermero Paliativo, CCEP, in Spanish). An interview-based qualitative study (1) was conducted to verify construct validity evidence, with psychometric properties of reliability and validity verified by two quantitative studies (2 & 3). DESIGN: Quantitative instrumental, correlational, and cross-sectional study. METHODS: Study 1 was carried out with 10 key informants. For Study 2, a sample of 103 nursing professionals was obtained and 176 nurses from palliative care resources in Spain participated in Study 3. Data were collected between May 2017 - May 2018. RESULTS: Evidence of adequate reliability (internal consistency) and validity was found. The confirmatory factor model yielded a single latent factor for the 20 items, with adequate goodness-of-fit indices. The convergent validity data showed that the highest correlations were with the Dedication subscale of the Utrecht Work Engagement Scale and the Personal Growth subscale of Psychological Well-being, with values of 0.35 and 0.34, respectively (p < 0.01 in both cases). CONCLUSION: The scale shows good psychometric properties, with high internal consistency and evidence of internal and convergent validity. IMPACT: Proposing a valuable instrument which identifies good nursing in different areas of palliative care while also establishing quality indicators to guide nursing practice entails the recognition of autonomy in care. The resulting work tool can be used to systematize the assessment of nursing care in a process of open and continuous improvement.

Quality of life, psychological well-being, and resilience in caregivers of people with acquired brain injury (ABI).

Aim: The study aims to examine whether characteristics of patients with Acquired Brain Injury-ABI (time elapsed since injury, level of dependence and behavioral problems) and resilience factors of the caregiver predicted caregiver well-being (quality of life, anxiety,depression and positive aspects of caregiving).Methods: 78 voluntary family caregivers (75.6% female) of patients with ABI completed the Barthel Index, Head Behavior Injury Scale, Questionnaire of Resilience in Caregivers of Acquired Brain Injury, WHOQOL-BREF, Hospital Anxiety and Depression Scale,and Positive Aspects of Caregiving Scale. Correlation analysis and stepwise regression were carried out.Results: Time elapsed since injury showed a negative relationship with positive aspects of caregiving. On the other hand, care-recipients' behavioral problems showed significant associations with all caregiver variables: negatively with quality of life and positive aspects of caregiving, and positively with anxiety and depression. Regarding resilience, we found a positive relationship with quality of life and positive aspects of caregiving, and a negative association with anxiety and depression, showing better predictive power with depression.Conclusions: We confirm the relevance of developing multidisciplinary caregiver intervention programmes focused on positive ways to handle care-recipients' behavioral problems and developing positive coping skills, such as positive reinterpretation, acceptance and seeking social support, that may optimize caregiver resilience.

Emotional Impact of COVID-19 Lockdown Among the Spanish Population.

BACKGROUND: The COVID-19 pandemic has resulted in some populations being confined to their homes as part of infection control measures. This situation can be hard to cope with due to separation from loved ones, prohibition of regular activities, fear of infection, loss of freedom, and so on. These negative impacts cause considerable psychological stress, and all the more so when the situation continues for an extended period, as was the case in Spain. The present study was aimed at investigating the effects of COVID-19 quarantine on the emotional functioning of confined Spanish individuals after 8 weeks of lockdown by means of a cross-sectional study. The possible associations between changes in emotional functioning and demographic variables (age and sex), health habits (physical exercise, following a routine, and smoking), social support, and resilience were also analyzed. METHODS: A total of 906 Spanish adults completed an online survey to gather information about their prevailing mood and affects (before and after 8 weeks of lockdown), using the Positive and Negative Affect Schedule (PANAS) (Watson et al., 1988), and other variables related to their habits and protective factors. FINDINGS: As expected, the data indicated an increase in negative affects (e.g., "upset," "afraid," "distressed") and a decrease in positive affects after 8 weeks under lockdown, as well as a general decline in overall mood. The largest increases in negative affects were observed in young adults (18-35 years) and women. We did not find any differences between people who were or were not diagnosed with COVID-19. Adhering to a routine, maintaining the same weight, and moderate physical exercise were associated with fewer negative affects, which indicates they are important protective factors, as are perceived social support and resilience. CONCLUSION: In order to mitigate the psychological impact of confinement, it is important to develop psychoeducational measures that encourage subjects to adhere to health habits and promote social support and resilience as protective factors. A special preventive focus should be placed on the most vulnerable population groups, namely women and young adults. For a public health lockdown to succeed, its negative consequences must be minimized insofar as possible through adequate knowledge of the risk factors and protective factors, and by means of prevention-oriented organization.

Paniculitis secundaria a terapia target en paciente con melanoma, lo que el dermatólogo debe saber: reporte de un caso / Panniculitis in association with target therapy in melanoma patient, what the dermatologist should know: a case report

Las terapias target constituyen hoy en día una alternativa terapéutica cada vez más utilizada para el manejo de pacientes con melanoma metastásico. Sin embargo, se han descrito múltiples efectos farmacológicos adversos asociados a su uso, siendo los cutáneos los de mayor prevalencia. Se presenta el caso de un hombre de 55 años con diagnóstico de melanoma cutáneo metastásico etapa IV, BRAFV600E mutado, en tratamiento con dabrafenib/trametinib que consultó por desarrollo de lesiones nodulares eritematosas sensibles en extremidades superiores e inferiores, asociadas a sensación febril durante el curso del tratamiento. Se descartó alguna infección sobreagregada. Se realizó una biopsia de las lesiones cutáneas, con confirmación diagnóstica histopatológica de una paniculitis mixta de predominio septal, granulomatosa y con vasculitis leucocitoclástica. La paniculitis asociada a esta terapia ha sido descrita en la literatura y se ha considerado un efecto farmacológico inmunomediado adverso, relacionándose a un mejor pronóstico para el melanoma metastásico en tratamiento. Por lo tanto, así como en el caso presentado, se evita la suspensión del fármaco y se asocia terapia sintomática en caso de mayores molestias del paciente. Es de alta relevancia para el dermatólogo conocer e interpretar adecuadamente este efecto adverso farmacológico, y así indicar el manejo más adecuado para el paciente.

Target therapies are currently a therapeutic option increasingly used for the management of patients with metastatic melanoma. However, there are multiple adverse pharmacological effects associated with their use that have been described. Cutaneous adverse reactions are the most frequent. We report the case of a 55-year-old man with a diagnosis of stage IV BRAFV600E-mutated metastatic cutaneous melanoma undergoing treatment with dabrafenib/trametinib, who consulted due to the development of erythematous nodular lesions in the upper and lower limbs associated with febrile sensation during the course of treatment. Infection was ruled out and a biopsy of the skin lesions was done, which provided the histopathological confirmation of a predominantly septal, granulomatous with leukocytoclastic vasculitis, mixed panniculitis. Panniculitis associated with this therapy has been described in the literature and has been considered an immune-mediated pharmacological adverse effect. It is considered to be related to a better prognosis in the treatment of metastatic melanoma. Consequently, as shown in this case report, target therapy should not be discontinued and symptomatic medication should be given to alleviate patient discomfort. The dermatologist should know and properly interpret this adverse effect and prescribe the most appropriate management for the patient.

Detrimental effects of chemotherapy on human coronary microvascular function.

Chemotherapy (CT) is a necessary treatment to prevent the growth and survival of cancer cells. However, CT has a well-established adverse impact on the cardiovascular (CV) system, even years after cessation of treatment. The effects of CT drugs on tumor vasculature have been the focus of much research, but little evidence exists showing the effects on the host microcirculation. Microvascular (MV) dysfunction is an early indicator of numerous CV disease phenotypes, including heart failure. The goal of this study was to evaluate the direct effect of doxorubicin (Dox) on human coronary MV function. To study the effect of CT on the cardiac MV function, flow-mediated dilation (FMD), pharmacologically-induced endothelial dependent dilation to acetylcholine (ACh), and smooth muscle-dependent dilation to papaverine were investigated. Vessels were freshly isolated from atrial appendages of adult patients undergoing cardiopulmonary bypass surgery or from cardiac tissue of pediatric patients, collected at the time of surgery to repair congenital heart defects. Isolated vessels were incubated in endothelial culture medium containing vehicle or Dox (100 nm, 15-20 h) and used to measure dilator function by video microscopy. Ex vivo treatment of adult human coronary microvessels with Dox significantly impaired flow-mediated dilation (FMD). Conversely, in pediatric coronary microvessels, Dox-induced impairment of FMD was significantly reduced in comparison with adult subjects. In both adult and pediatric coronary microvessels, ACh-induced constriction was reversed into dilation in the presence of Dox. Smooth muscle-dependent dilation remained unchanged in all groups tested. In vessels from adult subjects, acute treatment with Dox in clinically relevant doses caused significant impairment of coronary arteriolar function, whereas vessels from pediatric subjects showed only marginal impairment to the same stressor. This interesting finding might explain the delayed onset of future adverse CV events in children compared with adults after anthracycline therapy.NEW & NOTEWORTHY We have characterized, for the first time, human microvascular responses to acute ex vivo exposure to doxorubicin in coronary vessels from patients without cancer. Our data show an augmented impairment of endothelial function in vessels from adult subjects compared with pediatric samples.

Telomerase Deficiency Predisposes to Heart Failure and Ischemia-Reperfusion Injury.

Introduction: Elevated levels of mitochondrial reactive oxygen species (ROS) contribute to the development of numerous cardiovascular diseases. TERT, the catalytic subunit of telomerase, has been shown to translocate to mitochondria to suppress ROS while promoting ATP production. Acute overexpression of TERT increases survival and decreases infarct size in a mouse model of myocardial infarct, while decreased telomerase activity predisposes to mitochondrial defects and heart failure. In the present study, we examined the role of TERT on cardiac structure and function under basal conditions and conditions of acute or prolonged stress in a novel rat model of TERT deficiency. Methods: Cardiac structure and function were evaluated via transthoracic echocardiogram. Langendorff preparations were used to test the effects of acute global ischemia reperfusion injury on cardiac function and infarction. Coronary flow and left ventricular pressure were measured during and after ischemia/reperfusion (I/R). Mitochondrial DNA integrity was measured by PCR and mitochondrial respiration was assessed in isolated mitochondria using an Oxygraph. Angiotensin II infusion was used as an established model of systemic stress. Results: No structural changes (echocardiogram) or coronary flow/left ventricle pressure (isolated hearts) were observed in TERT-/- rats at baseline; however, after I/R, coronary flow was significantly reduced in TERT-/- compared to wild type (WT) rats, while diastolic Left Ventricle Pressure was significantly elevated (n = 6 in each group; p < 0.05) in the TERT-/-. Interestingly, infarct size was less in TERT-/- rats compared to WT rats, while mitochondrial respiratory control index decreased and mitochondrial DNA lesions increased in TERT-/- compared to WT. Angiotensin II treatment did not alter cardiac structure or function; however, it augmented the infarct size significantly more in TERT-/- compared to the WT. Conclusion: Absence of TERT activity increases susceptibility to stress like cardiac injury. These results suggest a critical role of telomerase in chronic heart disease.

La calidad del cuidado enfermero en el ámbito paliativo / The quality of nursing care in the palliative field / A qualidade de enfermagem no âmbito dos cuidados paliativos

El cuidado es la esencia de la profesión enfermera y cobra todo su sentido en el ámbito de paliativos. La enfermería de paliativos adquiere un papel relevante en la relación con el paciente y/o familia y acompañamiento en el sufrimiento. Analizar si los cuidados enfermeros proporcionados al paciente con enfermedad terminal y familiares, son o no de calidad, supone aspirar a una mejora continua y excelencia profesional. El objetivo de nuestro estudio es realizar una revisión teórica sobre la calidad del cuidado enfermero en el ámbito paliativo. Para ello, se consultó en las bases de datos Academic Search Complet, PsycInfo, CINAHL, CUIDEN y MEDLINE. Los resultados nos indican que la calidad de los cuidados enfermeros parece un campo poco investigado, y que los instrumentos de medida evalúan la calidad percibida desde la satisfacción del paciente, sólo en el ámbito hospitalario. Existe un amplio consenso sobre las dimensiones esenciales para evaluar la calidad de los cuidados paliativos, pero no se han encontrado escalas que midan específicamente la calidad del cuidado enfermero paliativo. La calidad se evalúa, por tanto, a través de las competencias enfermeras avanzadas y valores del profesional enfermero en paliativos

Care is the essence of the nursing profession and takes full meaning in the field of palliative care. Palliative nursing acquires an important role in the relationship with the patient and/or family and accompaniment in suffering. Analysing whether there is quality or not in the nursing care provided to the patient with terminal illness and his family, helps to build continuous improvement and professional excellence. The aim of our study is to carry out a theoretical review on the quality of nursing care in the field of palliative care. For this purpose, we worked with the databases Academic Search Complet, PsycInfo, CINAHL, CUIDEN and MEDLINE. The results indicate that the quality of nursing care seems to be a poorly researched field, and that the instruments of measurement evaluate the perceived quality from patient satisfaction, only in the hospital setting. There is a broad consensus on the essential dimensions for assessing the quality of palliative care, but no scales have been found that specifically measure the quality of nursing palliative care. Quality is therefore evaluated through advanced nursing competencies and nursing professional values in palliative care

O cuidado é a essência da profissão enfermeira e cobra todo o seu sentido na área de paliativos. A enfermeira de paliativos adquire um papel relevante na relação com o paciente e/ou família bem como no acompanhamento no sofrimento. Analisar se os cuidados proporcionados fornecidos ao paciente com doença terminal e familiares, têm ou não qualidade, supõe aspirar a uma melhora continua e à excelência profissional. O objetivo do nosso estudo é realizar uma revisão teórica sobre a qualidade da assistência do enfermeiro no âmbito dos cuidados paliativos. Com esse objetivo, se consultaram as bases de dados da Academic Search Complet, PsycInfo, CINAHL, CUIDEN y MEDLINE. Os resultados nos indicam que a qualidade dos cuidados enfermeiros parece ser um campo pouco investigado, e que os instrumentos de medida que avaliam a qualidade percebida a partir da satisfação do paciente, são apenas no âmbito hospitalário. Existe um amplio consenso sobre as dimensões essenciais para avaliar a qualidade dos cuidados paliativos, mas não se encontrou as escalas para medir especificamente a qualidade do cuidado do enfermeiro paliativo. A qualidade se avalia, por tanto, através das competências enfermeiras avançadas e valores do profissional enfermeiro em paliativos

Myosin-IIA heavy chain phosphorylation on S1943 regulates tumor metastasis.

Nonmuscle myosin-IIA (NMHC-IIA) heavy chain phosphorylation has gained recognition as an important feature of myosin-II regulation. In previous work, we showed that phosphorylation on S1943 promotes myosin-IIA filament disassembly in vitro and enhances EGF-stimulated lamellipod extension of breast tumor cells. However, the contribution of NMHC-IIA S1943 phosphorylation to the modulation of invasive cellular behavior and metastasis has not been examined. Stable expression of phosphomimetic (S1943E) or non-phosphorylatable (S1943A) NMHC-IIA in breast cancer cells revealed that S1943 phosphorylation enhances invadopodia function, and is critical for matrix degradation in vitro and experimental metastasis in vivo. These studies demonstrate a novel link between NMHC-IIA S1943 phosphorylation, the regulation of extracellular matrix degradation and tumor cell invasion and metastasis.