Learning needs and the orientation received by patients in the preoperative period of myocardial revascularization.

OBJECTIVE: To identify the learning needs and the orientations received by patients in the preoperative period of coronary artery bypass surgery (CABG). METHOD: Descriptive study, with a qualitative approach. Data collection took place from January to April 2021, through interviews carried out with 13 pre-operative patients admitted to the cardiovascular unit of a university hospital in Northeastern Brazil. The data was analyzed using descriptive statistics and the content of the interviews was processed in the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Next, an analysis of textual and similarity classes was carried out. RESULTS: The learning needs that were analyzed were divided in five classes: events that precede the surgery in the hospital; instructions received about the surgery; sites and recovery time after surgery; general questions about the surgery and content for the educational resource. Patients reported needs related to the process of disease, surgical procedures, and care before and after surgery. With regard to orientation, 53.85% reported not having received any. FINAL CONSIDERATIONS: The study identified that patients seldom received orientation. They need education on topics related to the process of the illness, the heart, surgical procedures, exams, care environments, risks, benefits, results, and changes in lifestyle to maintain health and quality of life.

Sociodemographic and clinical characteristics of people with ostomy and the adaptive domains of Roy's theory: A cross-sectional study.

INTRODUCTION: The adaptation of people with ostomies may be associated with and affected by sociodemographic and clinical factors. The present study aimed to investigate the association between the sociodemographic and clinical characteristics and the adaptation of people with an intestinal stoma. METHOD: An analytical study, carried out through an interview with 200 patients with ostomy for five months. For that, it was applied to scale for the level of adaptation of ostomy patients to measure the physiological domains, self-concept, role function and interdependence and a questionnaire was used in which sociodemographic and clinical information. Descriptive and multivariate analyses were performed to test the study hypothesis. RESULTS: The study pointed out statistically significant associations with male sex, age group below 60, low education level, Stoma time less than one year, below one minimum wage, temporary permanence criteria and presence of complications relation to low scores of adaptation. CONCLUSIONS: The association of sociodemographic and clinical factors with the measured adaptive modes provides important information for the planning of nursing care and other care providers, since it directs actions to the aspects that give greater adaptive difficulty to people with stomas and which are the focus of care nursing to this clientele.

Self-Care Requisites for People with Intestinal Ostomies: A Scoping Review / Requisitos de autocuidado para pessoas com estomias intestinais: revisão de escopo / Requisitos de autocuidado a personas con ostomías intestinales: revisión de alcance

Self-care is one of the main factors altered in the life of a person with an ostomy. Self-care requisites with nursing support are necessary. Objectives: To map the self-care requisites for people with intestinal ostomies in their adaptive process, guided by Orem's theory. Materials and methodology: A scoping review was conducted between May and June 2022, in which studies published from 2000 to 2022 were selected, based on Orem's self-care deficit nursing theory. The sources of evidence used were Medical Literature Analysis and Retrieval System Online, Cinahl, Scopus, Latin American and Caribbean Health Sciences Literature, Nursing database, Índice Bibliográfico Español en Ciencias de la Salud, Web of Science, Scientific Electronic Library Online, Brazilian Digital Library of Theses and Dissertations, Open Access Scientific Repositories of Portugal, Theses Canada, DART-Europe E-Theses Portal, and National ETD Portal. Studies presenting at least one requisite of self-care for people with intestinal ostomies, whether or not they addressed Orem's theory, and that were published in full were included. We followed the recommendations of the Joanna Briggs Institute and the PRISMA International Guide, registered in the Open Science Framework (10.17605/OSF.IO/XRH5K). The following descriptors and search strategies were used: (ostomy OR colostomy OR ileostomy OR stoma) AND (self-care OR self-management) AND (adaptation OR adjustment). Results: The final sample was composed of 87 studies. In universal requisites, studies in the category "nutritional aspects" predominated, of which the most frequent was "eat regularly and follow a balanced diet" (23; 26.4%); in developmental requisites, the prevalent category was "stoma and peristomal skin care" and requisite "assess peristomal skin integrity" (27; 31.0%); in the health deviation requisites, the predominant category was "choice of collection equipment and adjuvant products" and the requisite "use hydrocolloid powder to absorb moisture in cases of dermatitis" (13; 14.9%). Conclusions: The study contributes to guiding the assistance to the person with an ostomy, improving the self-care learning process. However, new intervention studies are still needed.

O autocuidado é um dos principais fatores alterados na vida da pessoa com estomia. Requisitos de autocuidado com o apoio da enfermagem são necessários. Objetivos: mapear os requisitos de autocuidado para pessoas com estomia intestinal em seu processo adaptativo, norteado pela teoria de Orem. Materiais e método: revisão de escopo realizada entre maio e junho de 2022, na qual foram selecionados estudos publicados de 2000 a 2022, com base no referencial da teoria de enfermagem do déficit do autocuidado de Orem. Utilizaram-se como fontes de evidência Medical Literature Analysis and Retrieval System Online, Cinahl, Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de dados em Enfermagem, Índice Bibliográfico Español en Ciencias de la Salud, Web of Science, Scientific Electronic Library Online, Biblioteca Digital Brasileira de Teses e Dissertações, Repositório Científico de Acesso Aberto de Portugal, Theses Canada, DART-Europe E-Theses Portal e National ETD Portal. Incluíram-se estudos que apresentassem pelo menos um requisito de autocuidado para pessoas com estomias intestinais, que abordassem ou não a teoria de Orem e publicados na íntegra. Seguiram-se as recomendações da Joanna Briggs Institute e do Prisma International Guide, com registro na Open Science Framework (10.17605/OSF.IO/XRH5K). Usaram-se os seguintes descritores e estratégias de busca: (ostomy OR colostomy OR ileostomy OR stoma) AND (self care OR self-management) AND (adaptation OR adjustment). Resultados: a amostra final foi composta de 87 estudos. Nos requisitos universais, predominaram estudos na categoria "aspectos nutricionais", dos quais o mais frequente foi "comer regularmente e seguir uma dieta equilibrada" (23; 26,4 %); nos requisitos de desenvolvimento, a categoria prevalente foi "cuidados com a estomia e a pele periestomal" e o requisito, "avaliar a integridade da pele periestomal" (27; 31,0 %); nos requisitos de desvio de saúde, a categoria predominante foi "escolha do equipamento coletor e dos produtos adjuvantes", e o requisito, "usar pó hidrocoloide para absorver a umidade em casos de dermatite" (13; 14,9 %). Conclusões: o estudo contribui para nortear a assistência à pessoa com estomia, melhorando o processo de aprendizado do autocuidado. Contudo, novos estudos de intervenção ainda são necessários.

El autocuidado es uno de los principales factores en la vida de la persona con ostomía. Requisitos de autocuidado con el soporte de la enfermería son necesarios. Objetivos: mapear los requisitos de autocuidado a personas con ostomía intestinal en su proceso adaptativo, norteado por la teoría de Orem. Materiales y método: revisión de alcance llevada a cabo entre mayo y junio de 2022, en la que se seleccionaron estudios publicados de 2000 a 2022, desde el marco de la teoría de enfermería del déficit del autocuidado de Orem. Se emplearon como fuentes de evidencia Medical Literature Analysis and Retrieval System Online, Cinahl, Scopus, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Base de datos en Enfermería, Índice Bibliográfico Español en Ciencias de la Salud, Web of Science, Scientific Electronic Library Online, Biblioteca Digital Brasileira de Teses e Dissertações, Repositório Científico de Acesso Aberto de Portugal, Theses Canada, DART-Europe E-Theses Portal y National ETD Portal. Se incluyeron estudios que presentaran al menos un requisito de autocuidado a personas con ostomías intestinales, que abordaran o no la teoría de Orem y publicados en la íntegra. Se siguieron las recomendaciones de Joanna Briggs Institute y Prisma International Guide, con registro en la Open Science Framework (10.17605/OSF.IO/XRH5K). Se emplearon los siguientes descriptores y estrategias de búsqueda: (ostomy OR colostomy OR ileostomy OR stoma) AND (self care OR self-management) AND (adaptation OR adjustment). Resultados: la muestra final fue de 87 estudios. En los requisitos universales, predominaron estudios en la categoría "aspectos nutricionales", de los cuales el más frecuente fue "comer regularmente y seguir una dieta balanceada" (23; 26,4 %); en los requisitos de desarrollo, la categoría prevalente fue "cuidados con la ostomía y la piel periestomal" y el requisito, "evaluar la integridad de la piel periestomal" (27; 31,0 %); en los requisitos de desviación de la salud, la categoría predominante fue "selección del equipo recolector y los productos adyuvantes", y el requisito, "usar polvo hidrocoloide para absorber la humidad en casos de dermatitis" (13; 14,9 %). Conclusiones: el estudio aporta a la orientación de la atención a la persona con ostomía, lo que puede mejorar el proceso de aprendizaje del autocuidado. Sin embargo, nuevos estudios de intervención aún son necesarios.

The effect of simulation on nursing students' knowledge about colostomy irrigation: a quasi-experimental study / Efecto de la simulación en los conocimientos de estudiantes de enfermería sobre irrigación de colostomía: estudio cuasiexperimental / Efeito da simulação no conhecimento de estudantes de enfermagem sobre irrigação de colostomia: estudo quase experimental

ABSTRACT Objective: to compare the effect of clinical simulation and of a lectured class on Nursing students' knowledge about the colostomy irrigation procedure. Method: a quasi-experimental study conducted in September 2019 with Nursing students attending Universidade Federal do Rio Grande do Norte in Natal, Brazil. The instruments used were a questionnaire targeted at sociodemographic issues and a knowledge analysis tool at three different moments. The Control Group had a lectured class and the Intervention Group took part in the laboratory simulation. The Chi-Square and Mann-Whitney tests were used for data analysis. Results: no statistically significant differences were observed between the groups in terms of the sociodemographic profile. In the analysis of the means of correct answers, better measures were observed in the post-test of both groups when compared to the pre-test; however, in the retention test, the students from the Intervention Group had better and statistically significant results than those from the Control Group (p-value=0.015). Conclusion: it is noticed that both teaching strategies exerted a positive effect on the students' learning process. Although both are equally important and effective, simulation showed better performance in knowledge retention. It is expected that this research enables educators to reflect on their work and allows them to use strategies that enhance their teaching practice, in order to benefit teaching and the students' development.

RESUMEN Objetivo: comparar el efecto de la simulación clínica y de una clase expositiva en los conocimientos de estudiantes de Enfermería sobre el procedimiento de irrigación de colostomía. Método: estudio cuasiexperimental realizado en septiembre de 2019 con estudiantes de Enfermería de la Universidade Federal do Rio Grande do Norte en Natal, Brasil. Como instrumentos se utilizaron un cuestionario dirigido a cuestiones sociodemográficas y una herramienta de análisis del conocimiento, en tres ocasiones diferentes. Al Grupo Control se le ofreció la clase expositiva y el Grupo Intervención participó de la simulación en laboratorio. Para el análisis de los datos se emplearon las pruebas de Chi-Cuadrado y de Mann-Whitney. Resultados: no se observaron diferencias estadísticas significativas entre los grupos en relación con el perfil sociodemográfico. En el análisis de los valores medios de respuestas correctas se observaron mejores medidas en el post-test de ambos grupos, en comparación con el pre-test; sin embargo, en el test de retención, los estudiantes del Grupo Intervención obtuvieron mejores resultados que los del Grupo Controle, además de ser estadísticamente significativos (valor p =0,015). Conclusión: se percibió que ambas estrategias de enseñanza produjeron un efecto positivo en el proceso de aprendizaje de los estudiantes. Aunque ambas son importantes y eficaces, la simulación presentó mejor desempeño en la retención de conocimientos. Se espera que este trabajo de investigación permita que los educadores reflexiones acerca de su trabajo y haga posible la utilización de estrategias que mejoren su práctica docente, a fin de beneficiar la educación y el desarrollo de los estudiantes.

RESUMO Objetivo: comparar o efeito da simulação clínica e da aula expositiva dialogada no conhecimento de estudantes de enfermagem sobre o procedimento de irrigação de colostomia. Método: estudo quase experimental, realizado em setembro de 2019 com acadêmicos de enfermagem da Universidade Federal do Rio Grande do Norte, em Natal, Brasil. Utilizaram-se como instrumentos um questionário voltado para questões sociodemográficas e um de análise de conhecimento em três diferentes ocasiões. O grupo controle teve aula expositiva dialogada e o grupo intervenção participou da simulação em laboratório. Para análise de dados foram usados os testes Qui-Quadrado e o de Mann-Whitney. Resultados: observou-se ausência de diferenças estatísticas significantes entre os grupos quanto ao perfil sociodemográfico. Na análise das médias de acertos, observaram-se melhores medidas no pós-teste dos dois grupos, quando comparado ao pré-teste, contudo, no teste de retenção os discentes do grupo intervenção tiveram resultados melhores que o grupo controle e estatisticamente significantes (p-valor=0,015). Conclusão: percebeu-se que as duas estratégias de ensino produziram efeito positivo no processo de aprendizagem dos discentes. Apesar de ambas serem importantes e eficazes, a simulação apresentou melhor desempenho na retenção do conhecimento. Espera-se que a pesquisa possibilite aos educadores a reflexão de seu trabalho e oportunize a utilização de estratégias que aprimorem sua prática docente, com vistas a beneficiar o ensino e desenvolvimento dos estudantes.

Autocuidado de pessoas com estomias intestinais: implicações para o cuidado de enfermagem / Auto cuidado de personas con estomía intestinal: implicaciones para el cuidado de enfermería / Self-care of people with intestinal stoma: implications for nursing care

RESUMO Objetivo: compreender as dificuldades enfrentadas pelas pessoas com estomias intestinais a partir das vivências de autocuidado. Método: trata-se de estudo descritivo, qualitativo, realizado com 30 pessoas com estomias intestinais, em um centro especializado em reabilitação no Rio Grande do Norte, de abril a junho de 2017. A entrevista semiestruturada foi gravada, transcrita e os dados coletados foram analisados seguindo-se os pressupostos da análise de conteúdo de Bardin. Resultados: a partir das vivências de autocuidado mencionadas pelos participantes, emergiram as dificuldades agrupadas nas categorias: higiene e manuseio do equipamento coletor; necessidades de cuidado com a pele periestomal; equipamento coletor e os episódios de vazamento; convívio social após a estomia; dificuldades e potencialidades da assistência de Enfermagem. As pessoas com estomias apresentaram dificuldades relacionadas a limpeza do estoma, recorte do equipamento coletor, aparecimento de complicações periestomiais, vazamentos de efluentes, afastamento de atividades sociais e informações insuficientes sobre o autocuidado. Considerações Finais: diante das dificuldades encontradas, torna-se necessário refletir sobre as mudanças nas práticas assistenciais para desenvolver o autocuidado da população com estomias, as quais podem se beneficiar do uso de tecnologias educativas instituídas desde o período pré-operatório. Este estudo contribui para a compreensão das experiências de autocuidado vivenciadas por essa população, a serem abordadas pela Enfermagem na promoção da educação em saúde. Além disso, espera-se que o estudo subsidie pesquisas com novas estratégias para fortalecer a assistência a esse público e o avanço da ciência de Enfermagem.

RESUMEN Objetivo: comprender las dificultades que enfrentan las personas con ostomía intestinal a partir de las experiencias de autocuidado. Método: se trata de un estudio descriptivo, cualitativo, realizado con 30 personas con ostomía intestinal, en un centro de rehabilitación especializado en Rio Grande do Norte, de abril a junio de 2017. La entrevista semiestructurada fue grabada, transcrita y los datos recolectados fueron analizados siguiendo los supuestos del análisis de contenido de Bardin. Resultados: de las experiencias de autocuidado mencionadas por los participantes surgieron dificultades, agrupadas en las siguientes categorías: higiene y manejo de los equipos recolectores; necesidades de cuidado de la piel periostomal; equipos de recolección y episodios de fugas; interacción social después de la ostomía; dificultades y potencialidades del cuidado de enfermería. Las personas con ostomías tuvieron dificultades relacionadas con la limpieza de la estoma, corte del equipo de recolección, aparición de complicaciones periostomales, fuga de efluentes, retiro de actividades sociales e información insuficiente sobre el autocuidado. Consideraciones finales: dadas las dificultades encontradas, es necesario reflexionar sobre cambios en las prácticas de cuidado para desarrollar el autocuidado de la población con ostomías, que puede beneficiarse del uso de tecnologías educativas introducidas en el período preoperatorio. Este estudio contribuye a la comprensión de las experiencias de autocuidado vividas por esta población, para ser abordadas por enfermería en la promoción de la educación para la salud. Además, se espera que el estudio subsidie la investigación con nuevas estrategias para fortalecer la asistencia a esta audiencia y el avance de la ciencia de Enfermería.

ABSTRACT Objective: to understand the difficulties faced by people with intestinal stoma based on self-care experiences. Method: this is a descriptive, qualitative study carried out with 30 people with intestinal stoma, in a specialized rehabilitation center in Rio Grande do Norte, from April to June 2017. The semi-structured interview was recorded, transcribed and the data collected were collected. analyzed following the assumptions of Bardin's content analysis. Results: from the self-care experiences mentioned by the participants, the difficulties grouped in the categories emerged: hygiene and handling of collecting appliance; peristomal skin care needs; collecting appliance and leakage episodes; social interaction after the ostomy; difficulties and potentialities of Nursing care. People with stoma had difficulties related to cleaning the stoma, cutting the collecting appliance, the appearance of peristomal complications, effluent leakage, withdrawal from social activities and insufficient information about self-care. Final Considerations: given the difficulties encountered, it is necessary to reflect on changes in care practices to develop self-care for the population with ostomies, which can benefit from the use of educational technologies instituted since the preoperative period. This study contributes to the understanding of the self-care experiences lived by this population, to be addressed by Nursing in the promotion of health education. In addition, it is expected that the study will support research with new strategies to strengthen assistance to this public and the advancement of Nursing science.

Construção e Validade da Escala do Nível de Adaptação da Pessoa com Estomia / Construction and Validity of the Adaptation Level Scale of the Person With Ostomy / Construcción y Validez de la Escala del Nivel de Adaptación de la Persona con Ostomia

Objetivo:Construir e validar o conteúdo da escala de verificação do nível de adaptação da pessoa com estomia. Método: Estudo metodológico envolvendo duas etapas: construção baseada em duas revisões integrativas da literatura e estudo qualitativo com pessoas com estomia; e validade de conteúdo com juízes dos seguintes critérios: comportamental, objetividade, relevância, clareza, simplicidade, variedade em relação à linguagem; realização do teste-piloto com o grupo-alvo; correção léxica e gramatical e nova submissão para o índice de validade de conteúdo. Resultados: Na primeira etapa, treze itens receberam sugestões de melhoria, três itens foram unificados por similaridade e um foi excluído. Após os ajustes, alcançou-se consenso dos juízes quanto à representatividade dos itens e à permanência nos modos a partir dos critérios avaliados. A população-alvo julgou os itens como de fácil entendimento ocorrendo em seguida correção gramatical e lexical. Conclusão: A escala apresentou evidência de validade de conteúdo demonstrando consenso entre os juízes e a população-alvo.

Objective:To construct and validate the content of the scale for verifying the level of adaptation of the person with ostomy. Method: Methodological study involving two stages: construction based on two integrative literature reviews and qualitative study with people with stomas; and content validity with judges of the following criteria: behavioral, objectivity, relevance, clarity, simplicity, variety in relation to language; carrying out the pilot test with the target group; lexical and grammatical correction and resubmission to the content validity index. Results: in the first stage, thirteen items received suggestions for improvement, three items were unified by similarity and one was excluded. After the adjustments, a consensus was reached among the judges regarding the representativeness of the items and permanence in the modes based on the evaluated criteria. The target population judged the items as easy to understand, followed by grammatical and lexical correction. Conclusion: The scale presented evidence of content validity demonstrating consensus between the judges and the population.

Objetivo:Construir y validar el contenido de la escala de verificación del nivel de adaptación de la persona con ostomía. Método: Estudio metodológico que involucra dos etapas: construcción a partir de dos revisiones integrativas de la literatura y estudio cualitativo con personas con estomas; y validez de contenido con jueces de los siguientes criterios: conductual, objetividad, pertinencia, claridad, sencillez, variedad en relación al lenguaje; realización de la prueba piloto con el grupo objetivo; corrección léxica y gramatical y reenvío al índice de validez de contenido. Resultados: en la primera etapa, 13 ítems recibieron sugerencias de mejora, tres ítems fueron unificados por similitud y uno fue excluido. Luego de los ajustes, se llegó a un consenso entre los jueces respecto a la representatividad de los ítems y permanencia en las modalidades con base en los criterios evaluados. La población objetivo juzgó los ítems como fáciles de entender, seguidos de corrección gramatical y léxica. Conclusión: La escala presentó evidencias de validez de contenido demostrando consenso entre los jueces y la población.

Remodelling of colorectal cancer cell signalling by microbiota and immunity in diabetes.

Obesity is the strongest known risk factor to develop type 2 diabetes (T2D) and both share a state of chronic, diffuse and low-grade inflammation, impaired immune responses and alterations in the composition and function of the microbiome. Notably, these hallmarks are shared with colorectal cancer (CRC), which is epidemiologically associated to obesity and T2D. Gut barrier damages in T2D destabilize the microbiome that metabolizes the diet and modulates the host immune response triggering inflammatory and proliferative pathways. In this review, we discuss the pathways altered by defects in the immune response and microbiota that may link T2D to CRC development. Stressed adipocytes, metabolic incongruity in blood and gut barrier failure with dysbiosis cooperate to establish imbalances between immune innate and adaptive cells and cytokines such as interleukin 6 (IL6) or TNFA that define low-grade diffuse inflammation in T2D. Inflammation drives tissue repair through proliferation and migration (critical mechanisms for tumourigenesis) and under physiological conditions feeds anti-inflammatory cytokine production to resolve the process. The disproportion in pro- vs anti-inflammatory cells and cytokines imposed by T2D will impact the tumour micro- and macro-environment, favouring tumour proliferation, angiogenesis and decreased immune responses. Complex bidirectional relationships between the metabolic environment of T2D, gut microbiota, and immune dysfunctions may favour tumour cell demands and will define the outcome. Animal models developed to study the relationships between T2D and CRC in the context of microbiota and immune system are discussed.

Metabolic and hormonal remodeling of colorectal cancer cell signalling by diabetes.

The existence of molecular links that facilitate colorectal cancer (CRC) development in the population with type 2 diabetes (T2D) is supported by substantial epidemiological evidence. This review summarizes how the systemic, metabolic and hormonal imbalances from T2D alter CRC cell metabolism, signalling and gene expression as well as their reciprocal meshing, with an overview of CRC molecular subtypes and animal models to study the diabetes-CRC cancer links. Metabolic and growth factor checkpoints ensure a physiological cell proliferation rate compatible with limited nutrient supply. Hyperinsulinaemia and hyperleptinaemia in prediabetes and excess circulating glucose and lipids in T2D overcome formidable barriers for tumour development. Increased nutrient availability favours metabolic reprogramming, alters signalling and generates mutations and epigenetic modifications through increased reactive oxygen species and oncometabolites. The reciprocal control between metabolism and hormone signalling is lost in diabetes. Excess adipose tissue at the origin of T2D unbalances adipokine (leptin/adiponectin) secretion ratios and function and disrupts the insulin/IGF axes. Leptin/adiponectin imbalances in T2D are believed to promote proliferation and invasion of CRC cancer cells and contribute to inflammation, an important component of CRC tumourigenesis. Disruption of the insulin/IGF axes in T2D targets systemic and CRC cell metabolic reprogramming, survival and proliferation. Future research to clarify the molecular diabetes-CRC links will help to prevent CRC and reduce its incidence in the diabetic population and must guide therapeutic decisions.

Paradoxical activation of AMPK by glucose drives selective EP300 activity in colorectal cancer.

Coordination of gene expression with nutrient availability supports proliferation and homeostasis and is shaped by protein acetylation. Yet how physiological/pathological signals link acetylation to specific gene expression programs and whether such responses are cell-type-specific is unclear. AMP-activated protein kinase (AMPK) is a key energy sensor, activated by glucose limitation to resolve nutrient supply-demand imbalances, critical for diabetes and cancer. Unexpectedly, we show here that, in gastrointestinal cancer cells, glucose activates AMPK to selectively induce EP300, but not CREB-binding protein (CBP). Consequently, EP300 is redirected away from nuclear receptors that promote differentiation towards ß-catenin, a driver of proliferation and colorectal tumorigenesis. Importantly, blocking glycogen synthesis permits reactive oxygen species (ROS) accumulation and AMPK activation in response to glucose in previously nonresponsive cells. Notably, glycogen content and activity of the ROS/AMPK/EP300/ß-catenin axis are opposite in healthy versus tumor sections. Glycogen content reduction from healthy to tumor tissue may explain AMPK switching from tumor suppressor to activator during tumor evolution.

Validation of educational material for the care of people with intestinal stoma.

OBJECTIVE: to validate an educational booklet for people with intestinal stoma as a technological resource in the teaching of self-care. METHOD: a methodological research for the construction and validation of an educational booklet by nine expert judges and 25 people with stomas. The agreement index of at least 80% was considered to guarantee the validation of the material. RESULTS: regarding the objectives of the booklet, all the judges evaluated the items as "adequate" or "totally adequate", with a content validity index of 1.00. Regarding the structure and presentation of the booklet, the total index was 0.84. Regarding relevance, the total was 0.97 and the general index of the educational booklet was 0.89, confirming the validation with the judges. All items of the organization, writing style, appearance and motivation of the material were considered as validated by the target audience, reaching a total agreement index of 0.99. CONCLUSION: in the context of health education, the booklet was considered valid and suitable for the care of people with intestinal stoma, and can be used in teaching, research, extension and care for people with intestinal stoma.

Validation of educational material for the care of people with intestinal stoma / Validação de material educativo para o cuidado da pessoa com estomia intestinal / Validación de material educativo para el cuidado de la persona con ostomía intestinal

Abstract Objective: to validate an educational booklet for people with intestinal stoma as a technological resource in the teaching of self-care. Method: a methodological research for the construction and validation of an educational booklet by nine expert judges and 25 people with stomas. The agreement index of at least 80% was considered to guarantee the validation of the material. Results: regarding the objectives of the booklet, all the judges evaluated the items as "adequate" or "totally adequate", with a content validity index of 1.00. Regarding the structure and presentation of the booklet, the total index was 0.84. Regarding relevance, the total was 0.97 and the general index of the educational booklet was 0.89, confirming the validation with the judges. All items of the organization, writing style, appearance and motivation of the material were considered as validated by the target audience, reaching a total agreement index of 0.99. Conclusion: in the context of health education, the booklet was considered valid and suitable for the care of people with intestinal stoma, and can be used in teaching, research, extension and care for people with intestinal stoma.

Resumo Objetivo: validar uma cartilha educativa para pessoas com estomias intestinais como recurso tecnológico no ensino do autocuidado. Método: pesquisa metodológica para a construção e validação de cartilha educativa por nove juízes especialistas e 25 pessoas com estomias. Foi considerado o índice de concordância de, no mínimo, 80% para se garantir a validação do material. Resultados: quanto aos objetivos da cartilha, todos os juízes avaliaram os itens como "adequado" ou "totalmente adequado", com índice de validade de conteúdo de 1,00. Com relação à estrutura e apresentação da cartilha, o índice total foi de 0,84. No quesito relevância, o total foi de 0,97 e o índice geral da cartilha educativa foi de 0,89, confirmando a validação junto aos juízes. Todos os itens da organização, estilo da escrita, aparência e motivação do material foram considerados validados pelo público-alvo, atingindo índice de concordância total de 0,99. Conclusão: no contexto da educação em saúde, a cartilha foi considerada válida e adequada para o cuidado das pessoas com estomias intestinais, podendo ser utilizada em ambientes de ensino, pesquisa, extensão e no cuidado à pessoa com estomia intestinal.

Resumo Objetivo: validar una guía educativa para personas con ostomías intestinales, como recurso tecnológico en la enseñanza del autocuidado. Método: investigación metodológica para la construcción y validación de una guía educativa por nueve jueces especialistas y 25 personas con ostomías. Se consideró el índice de concordancia mínimo de 80% para garantizar la validación del material. Resultados: en cuanto a los objetivos de la guía, todos los jueces evaluaron los ítems como "adecuado" o "totalmente adecuado" con índice de validación de contenido de 1,00. En relación a la estructura y presentación de la guía, el índice fue de 0,84. En el punto atinente a la relevancia, el total fue de 0,97 y el índice general de la guía educativa fue de 0,89, confirmándose la validación junto a los jueces. Todos los ítems de la organización, estilo de escritura, apariencia y motivación del material fueron validados por el público destinatario, alcanzándose el índice de concordancia total de 0,99. Conclusión: En el contexto de educación en salud, la guía se consideró válida y adecuada para el cuidado de personas con ostomías intestinales, apta para ser utilizada en el ámbito educativo, investigaciones, extensión y en el cuidado a la persona con ostomía intestinal.

Biomarkers of basal cell carcinoma resistance to methyl-aminolevulinate photodynamic therapy.

BACKGROUND: Methyl-aminolevulinate photodynamic therapy (MAL-PDT) is an excellent option for the treatment of basal cell carcinoma (BCC). However, up to 25% of cases are resistant to this treatment modality. OBJECTIVE: The aim of this study was to identify potential biomarkers of BCC response to MAL-PDT. MATERIAL AND METHODS: Clinical, histological, and immunohistochemical (p53, Ki-67, CD-31, COX2, ß-catenin, EGFR, and survivin) variables were analyzed in a retrospective study of consecutive BCC patients treated with MAL-PDT at the San Jorge Hospital, Huesca, Spain between January 2006 and December 2015. To deepen on these markers, the effects on p53 and cyclin D1 expression, in vitro response to MAL-PDT of 2 murine BCC cell lines (ASZ and BSZ), was also evaluated. RESULTS: The retrospective study examined the response to MAL-PDT of 390 BCCs from 182 patients. The overall clinical response rate was 82.8%, with a mean follow-up time of 35.96 months (SD = 23.46). Immunohistochemistry revealed positive p53 in 84.6% of responders but only 15.4% of nonresponsive tumors (p = 0.011). Tumors with increased peripheral palisading of basal cell islands to immunostaining ß-catenin responded poorly to PDT (p = 0.01). In line with our findings in patients, in vitro studies revealed a better response to PDT in the p53-positive ASZ cell line than the p53-negative BSZ cell line (p<0.01). Multivariate analysis revealed that the following variables were significantly associated with response to PDT: age, nBCC, presence of peritumoral inflammatory infiltrate, and p53 immunopositivity. Patients with positive p53 immunostaining were 68.54 times more likely to achieve cure than p53-negative patients (CI95% 2.94-159.8). CONCLUSION: Our finding suggest that certain clinicopathological and immunohistochemical variables, particularly p53 expression, may serve as indicators of BCC response to MAL-PDT, and thus facilitate the selection of patients who are most likely to benefit from this therapy.

Mitotic Catastrophe Induced in HeLa Tumor Cells by Photodynamic Therapy with Methyl-aminolevulinate.

Photodynamic therapy (PDT) constitutes a cancer treatment modality based on the administration of a photosensitizer, which accumulates in tumor cells. The subsequent irradiation of the tumoral area triggers the formation of reactive oxygen species responsible for cancer cell death. One of the compounds approved in clinical practice is methyl-aminolevulinate (MAL), a protoporphyrin IX (PpIX) precursor intermediate of heme synthesis. We have identified the mitotic catastrophe (MC) process after MAL-PDT in HeLa human carcinoma cells. The fluorescence microscopy revealed that PpIX was located mainly at plasma membrane and lysosomes of HeLa cells, although some fluorescence was also detected at endoplasmic reticulum and Golgi apparatus. Cell blockage at metaphase-anaphase transition was observed 24 h after PDT by phase contrast microscopy and flow cytometry. Mitotic apparatus components evaluation by immunofluorescence and Western blot indicated: multipolar spindles and disorganized chromosomes in the equatorial plate accompanied with dispersion of centromeres and alterations in aurora kinase proteins. The mitotic blockage induced by MAL-PDT resembled that induced by two compounds used in chemotherapy, taxol and nocodazole, both targeting microtubules. The alterations in tumoral cells provided evidence of MC induced by MAL-PDT, resolving mainly by apoptosis, directly or through the formation of multinucleate cells.

Characterisation of resistance mechanisms developed by basal cell carcinoma cells in response to repeated cycles of Photodynamic Therapy.

Photodynamic Therapy (PDT) with methyl-aminolevulinate acid (MAL-PDT) is being used for the treatment of Basal cell carcinoma (BCC), but recurrences have been reported. In this work, we have evaluated resistance mechanisms to MAL-PDT developed by three BCC cell lines (ASZ, BSZ and CSZ), derived from mice on a ptch+/- background and with or without p53 expression, subjected to 10 cycles of PDT (10thG). The resistant populations showed mesenchymal-like structure and diminished proliferative capacity and size compared to the parental (P) cells. The resistance was dependent on the production of the endogenous photosensitiser protoporphyrin IX in the CSZ cell line and on its cellular localisation in ASZ and BSZ cells. Moreover, resistant cells expressing the p53 gene presented lower proliferation rate and increased expression levels of N-cadherin and Gsk3ß (a component of the Wnt/ß-catenin pathway) than P cells. In contrast, 10thG cells lacking the p53 gene showed lower levels of expression of Gsk3ß in the cytoplasm and of E-cadherin and ß-catenin in the membrane. In addition, resistant cells presented higher tumorigenic ability in immunosuppressed mice. Altogether, these results shed light on resistance mechanisms of BCC to PDT and may help to improve the use of this therapeutic approach.

Extract of Deschampsia antarctica (EDA) Prevents Dermal Cell Damage Induced by UV Radiation and 2,3,7,8-Tetrachlorodibenzo-p-dioxin.

Exposure to natural and artificial light and environmental pollutants are the main factors that challenge skin homeostasis, promoting aging or even different forms of skin cancer through a variety of mechanisms that include accumulation of reactive oxygen species (ROS), engagement of DNA damage responses, and extracellular matrix (ECM) remodeling upon release of metalloproteases (MMPs). Ultraviolet A radiation is the predominant component of sunlight causative of photoaging, while ultraviolet B light is considered a potentiator of photoaging. In addition, different chemicals contribute to skin aging upon penetration through skin barrier disruption or hair follicles, aryl hydrocarbon receptors (AhR) being a major effector mechanism through which toxicity is exerted. Deschampsia antarctica is a polyextremophile Gramineae capable of thriving under extreme environmental conditions. Its aqueous extract (EDA) exhibits anti- photoaging in human skin cells, such as inhibition of MMPs, directly associated with extrinsic aging. EDA prevents cellular damage, attenuating stress responses such as autophagy and reducing cellular death induced by UV. We demonstrate that EDA also protects from dioxin-induced nuclear translocation of AhR and increases the production of loricrin, a marker of homeostasis in differentiated keratinocytes. Thus, our observations suggest a potential use exploiting EDA's protective properties in skin health supplements.

Selective Oxidative Dearomatization of Angular Tetracyclic Phenols by Controlled Irradiation under Air: Synthesis of an Angucyclinone-Type Double Peroxide with Anticancer Properties.

Angular tetracyclic p-peroxyquinols, p-quinols, and a pentacyclic double peroxide, showing anticancer properties, were synthesized from the corresponding phenols by an environmentally friendly solvent- and wavelength-controlled irradiation under air in the absence of an external photosensitizer.

Na correnteza da vida: a descoberta da doença renal crônica / In the current of life: the discovery of chronic kidney disease / En la corriente de la vida: el descubrimiento de la enfermedad renal crónica

Reconstruir, a partir da escuta, a trajetória de vida de uma paciente renal crônica em tratamento hemodialítico constitui o objetivo deste artigo. Como procedimento metodológico, trabalhamos com a história oral de vida, utilizando a entrevista como principal instrumento. A análise se pauta nas narrativas da colaboradora, ancorada em estudos que tratam da história oral e da subjetividade humana, com destaque para a resiliência. Foi possível apreender, com sua trajetória de vida, que a superação das dificuldades é um marco da singularidade. Portanto, sua história nos leva a concluir que, apesar das adversidades e do sofrimento, existe no ser humano a força de navegar nas torrentes e conseguir ser feliz.(AU)

The aim of the present study is to reconstruct the life trajectory of a chronic kidney disease patient undergoing hemodialysis. We worked with oral life history, using the interview as the main instrument. Data analysis was based on her narratives, anchored in studies that address oral history and human subjectivity, which is uniquely marked by overcoming challenges. Thus, her story allows us to conclude that despite adversity and suffering, humans have the strength to navigate rough waters and achieve happiness.(AU)

Reconstruir, a partir de la escucha, la trayectoria de vida de una paciente renal crónica en tratamiento de hemodiálisis es el objetivo de este artículo. Como procedimiento metodológico trabajamos con la historia oral de vida, utilizando la entrevista como instrumento principal. El análisis se pauta en las narrativas de la colaboradora, anclado en estudios que tratan de la historia oral y de la subjetividad humana, subrayando la resiliencia. Fue posible captar, con su trayectoria de vida, que la superación de las dificultades es un marco de la singularidad. por lo tanto, su historia nos lleva a concluir que, a pesar de las adversidades y del sufrimiento, existe en el ser humano la fuerza de navegar por los torrentes y conseguir ser feliz.(AU)

Atividades da intervenção de enfermagem “cuidados com a ostomia” / Nursing intervention activities \"care for ostomy”

Objetivo: avaliar as evidências sobre as atividades propostas pela intervenção da NIC “Cuidados coma ostomia”. Método: revisão integrativa, realizada em março de 2016 nas bases de dados MEDLINE, CINAHL,Web of Science, SCOPUS e LILACS. Os estudos foram categorizados a partir da identificação das intervençõescondizentes com a taxonomia da intervenção na NIC >, bem como as atividadespropostas. Resultados: a coleta resultou em 23 artigos, de maioria qualitativos (52%), com nível de evidênciaIV (60,9%), identificando-se, nestes, 23 das 25 atividades de Enfermagem propostas na NIC, sendo a atividade“Orientar o paciente/pessoa importante quanto ao uso de dispositivo/cuidados de ostomia” a mais frequente(60,9%). Conclusão: verificou-se, portanto, que as ações mais frequentes realizadas pelos enfermeiros sereferem às orientações de manejo do ostoma com a inclusão do cuidador e que há necessidade de maisestudos com melhores níveis de evidência nessa temática.

Prevalência de complicações em pessoas com estomias urinárias e intestinais / Complications prevalence in people with urinary and intestinal ostomies

Objetiva-se identifi car a prevalência de complicações em pessoas com estomias urinárias e intestinais ativas cadastradas na Associação de Ostomizados do Rio Grande do Norte. Trata-se de uma pesquisa transversal, retrospectiva, com abordagem quantitativa realizada com 572 prontuários dos estomizados ativos atendidos na AORN de 1991 a 2015. Os resultados apresentaram predominância em indivíduos do sexo masculino (52,1%), ensino fundamental incompleto (51,6%) e renda de até dois salários mínimos (64,3%), sendo 76,2% colostomizados, 16,3% ileostomizados e 7,5% urostomizados. Entre as principais causas que levaram a confecção do estoma destacouse a neoplasia de reto (37,6%). A prevalência de complicações para o período pesquisado foi de 30,2%. Dentre as complicações mais frequentes destaca-se a dermatite (28,9%), prolapso (20,2%), hérnia periestomal (18,5%) e retração do estoma (17,9%). Concluí-se que a prevalência das complicações foi de 30,2% com maior frequência de dermatite, prolapso, hérnia e retração. Faz-se necessário a identifi cação das complicações precocemente evitando agravos

The aim is to identify the complications prevalence in people with active urinary stomies and intestines enrolled in the Ostomized Association of Rio Grande do Norte. This was a cross-sectional, retrospective study with a quantitative approach with 572 records of stomatal patients seen at AORN from 1991 to 2015. The results showed the follow predominance: males (52.1%), incomplete primary education (51.6%), Being 76.2% colostomized, 16.3% ileostomized and 7.5% urostomized. Among the main causes that led to the manufacture of the stoma, a rectal neoplasia (37.6%) was highlighted. The prevalence of complications for the period studied was 30.2%. Among the most frequent complications are dermatitis (28.9%), prolapse (20.2%), peristomal hernia (18.5%) and stoma retraction (17.9%). It concludes that the prevalence of complications was 30.2% with a higher frequency of dermatitis, prolapse, hernia and retraction. It is necessary a warning of complications early avoiding injuries

Combined Treatments with Photodynamic Therapy for Non-Melanoma Skin Cancer.

Non-melanoma skin cancer (NMSC) is the most common form of cancer in the Caucasian population. Among NMSC types, basal cell carcinoma (BCC) has the highest incidence and squamous cell carcinoma (SCC) is less common although it can metastasize, accounting for the majority of NMSC-related deaths. Treatment options for NMSC include both surgical and non-surgical modalities. Even though surgical approaches are most commonly used to treat these lesions, Photodynamic Therapy (PDT) has the advantage of being a non-invasive option, and capable of field treatment, providing optimum cosmetic outcomes. Numerous clinical research studies have shown the efficacy of PDT for treating pre-malignant and malignant NMSC. However, resistant or recurrent tumors appear and sometimes become more aggressive. In this sense, the enhancement of PDT effectiveness by combining it with other therapeutic modalities has become an interesting field in NMSC research. Depending on the characteristics and the type of tumor, PDT can be applied in combination with immunomodulatory (Imiquimod) and chemotherapeutic (5-fluorouracil, methotrexate, diclofenac, or ingenol mebutate) agents, inhibitors of some molecules implicated in the carcinogenic process (COX2 or MAPK), surgical techniques, or even radiotherapy. These new strategies open the way to a wider improvement of the prevention and eradication of skin cancer.