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Considerado um grave problema em saúde pública, as feridas crônicas são patologias que desafiam o manejo terapêutico e infelizmente acometem milhares de pessoas em todo o mundo. Essa doença apresenta altos índices de morbidade impactando negativamente na qualidade de vida dos seus portadores, além de influenciar negativamente no domínio "bem-estar", principalmente quando associado aos fatores clínicos podendo estar relacionado há anos de tratamento sem cura da ferida. As feridas crônicas são caracterizadas por demora ou dificuldade nos processos de cicatrização e reparação ordenada da integridade anatômica e funcional da pele durante um período de no mínimo três meses. Porém, algumas lesões permanecem por anos e até décadas sem cicatrizar. Objetivo: O escopo dessa revisão é mostrar o limitado arsenal terapêutico bem como a dificuldade no manejo clínico e dessa forma proporcionar uma reflexão sobre sua fisiopatologia e a urgente necessidade de novas opções e condutas terapêuticas que possam auxiliar no tratamento desses pacientes. Metodologia: Trata-se de uma revisão integrativa da literatura sobre feridas crônicas, cujo critérios de inclusão foram artigos publicados no período de janeiro de 2005 a fevereiro de 2023. Conclusão: A problemática acerca dessa patologia é vasta, tratando de uma doença de difícil cura, com uma gama de fatores associados que dificultam a cura da lesão, estendendo essa doença a altos índices de morbidade. Novas condutas terapêuticas e novos fármacos, precisam ser desenvolvidos urgentemente. Destaca-se que o uso de probióticos e o emprego da nanotecnologia tem mostrado um grande potencial inovador no tratamento de pacientes portadores de feridas crônicas.

Considered a serious public health problem, chronic wounds are pathologies that defy therapeutic management and unfortunately affect thousands of people around the world. This disease has high morbidity rates, negatively impacting the quality of life of its patients, in addition to negatively influencing the "well-being" domain, especially when associated with clinical factors, which may be related to years of treatment without healing of the wound. Chronic wounds are characterized by delay or difficulty in healing processes and orderly repair of the anatomical and functional integrity of the skin over a period of at least three months. However, some injuries remain for years and even decades without healing. Objective: The scope of this review is to show the limited therapeutic arsenal as well as the difficulty in clinical management and thus provide a reflection on its pathophysiology and the urgent need for new options and therapeutic approaches that can help in the treatment of these patients. Methodology: This is an integrative review of the literature on chronic wounds, whose inclusion criteria were articles published from January 2005 to February 2023. Conclusion: The problem surrounding this pathology is vast, dealing with a difficult-to-cure disease, with a range of associated factors that make healing of the lesion difficult, extending this disease to high morbidity rates. New therapeutic approaches and new drugs need to be developed urgently. It is noteworthy that the use of probiotics and the use of nanotechnology have shown great innovative potential in the treatment of patients with chronic wounds.

Consideradas un grave problema de salud pública, las heridas crónicas son patologías que desafían el manejo terapéutico y que, lamentablemente, afectan a miles de personas en todo el mundo. Esta enfermedad presenta altas tasas de morbilidad, impactando negativamente en la calidad de vida de sus pacientes, además de influir negativamente en el dominio "bienestar", especialmente cuando se asocia a factores clínicos, que pueden estar relacionados con años de tratamiento sin curación de la herida. Las heridas crónicas se caracterizan por un retraso o dificultad en los procesos de cicatrización y reparación ordenada de la integridad anatómica y funcional de la piel durante un periodo de al menos tres meses. Sin embargo, algunas heridas permanecen durante años e incluso décadas sin cicatrizar. Objetivo: El alcance de esta revisión es mostrar el limitado arsenal terapéutico así como la dificultad en el manejo clínico y así aportar una reflexión sobre su fisiopatología y la urgente necesidad de nuevas opciones y enfoques terapéuticos que puedan ayudar en el tratamiento de estos pacientes. Metodología: Se trata de una revisión integradora de la literatura sobre heridas crónicas, cuyos criterios de inclusión fueron artículos publicados desde enero de 2005 hasta febrero de 2023. Conclusiones: La problemática que rodea a esta patología es amplia, tratándose de una enfermedad de difícil curación, con una serie de factores asociados que dificultan la cicatrización de la lesión, extendiendo esta enfermedad a altas tasas de morbilidad. Es urgente desarrollar nuevos enfoques terapéuticos y nuevos fármacos. Cabe destacar que el uso de probióticos y el empleo de nanotecnología han mostrado un gran potencial innovador en el tratamiento de pacientes con heridas crónicas.

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BACKGROUND: The number of lung transplantations has been rising constantly. However, use of this therapeutic resource is limited by several issues that are difficult to resolve, such as chronic graft rejection and complications secondary to immunosuppression. METHODS: This systematic review compared mammalian target of rapamycin (mTOR) inhibitor immunosuppression associated with low-dose calcineurin inhibitors with isolated calcineurin inhibitor immunosuppression on the new-onset chronic rejection development and mortality 12 months after lung transplantation. Three controlled randomized clinical trials (SHITRIT, NOCTET, and 4EVERLUNG) were selected from electronic databases. RESULTS: Meta-analysis of the data at 12 months postintervention showed that only 4EVERLUNG assessed chronic graft rejection, with a higher incidence in the control group; however, the difference was not statistically significant (P = .197). Significant data were related to an increase in the number of adverse events (P = .0064) and improved renal function (P < .0001) in the mTOR inhibitor-based scheme. The other outcomes indicated a trend toward greater risk of death and acute graft rejection with the use of mTORs. CONCLUSIONS: The researchers suggest considering the use of mTOR inhibitors, whose greatest benefit is felt by patients with renal dysfunction, in association with the use of calcineurin inhibitors, because of the imminent risk of death among patients with renal failure.

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AIMS AND OBJECTIVES: We created and validated a checklist for nursing care of patients in the immediate postoperative period of cardiac surgery. BACKGROUND: Cardiovascular diseases (CVD) account for about 30% of all deaths recorded in Brazil. There is an arsenal of clinical and surgical treatments for CVD, with a significant number of patients evolving to surgical treatment. Thus, health professionals working in the perioperative period of cardiovascular surgeries need to be updated, trained and qualified to provide adequate and safe care to patients. DESIGN: We developed a checklist that defined essential parameters for quality care, to ensure greater agility and patient safety. METHODS: This methodology validation study comprised two stages: checklist creation for care provided by nurses to patients in the IPO of cardiac surgery, and content validation using the Delphi method. Participants were selected through an advanced survey conducted on the Lattes Platform website of the National Council for Scientific and Technological Development. The STROBE checklist was used to guide the study. RESULTS: Three rounds of analysis by specialists resulted in average CVIs of: 95.8% for objectivity, 97.9% for simplicity, 91.0% for clarity, 93.1% for relevance and 96.5% for variety, suggesting high agreement among specialists. CONCLUSIONS: The checklist focused on nursing care of patients in the IPO of cardiac surgery and was validated with three topics, four categories, 16 items and 86 sub-items of care assignments to be applied in clinical practice. RELEVANCE TO CLINICAL PRACTICE: This is a validated instrument that guides nurses' actions by admitting postoperative cardiac surgery patients to the ICU based on evidence, which provides more scientific and professional support to health teams' performance, with the objective of strengthening roles and establishing routines; thus presenting a powerful tool for planning nursing actions, providing quality care to patients, and facilitating communication between teams, thereby minimising risks.

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AIMS: To study the bladder structure of fetuses with prune belly syndrome (PBS). METHODS: We studied three bladders obtained from three male fetuses with PBS and seven bladders from seven male fetuses without anomalies. Each bladder was dissected and embedded in paraffin, from which 5 µm thick sections were obtained and stained with Masson's trichrome (to quantify connective tissue and smooth muscle) and picrosirius red with polarization (to observe collagen). Immunohistochemistry with tubulin (Tubulin, beta III, Mouse Monoclonal Antibody) was applied to observe the bladder nerves. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using the Mann-Whitney test (P < 0.05). RESULTS: Quantitative analysis documented that smooth muscle fibers were significantly smaller (P = 0.04) in PBS fetuses (9.67% to 17.75%, mean = 13.2%) compared to control group (13.33% to 26.56%, mean = 17.43%). The analysis of collagen fibers showed predominance of green in the control group, suggesting collagen type III presence, and predominance of red in the in PBS fetal bladders, suggesting collagen type I presence in this group. The qualitative analysis of the nerves with immunohistochemistry with tubulin showed predominance of nerves in the control group. CONCLUSION: The bladder in PBS had lower concentrations of smooth muscle fibers, collagen type III, and nerves. These structural alterations can be one of the factors involved in urinary tract abnormality such as distended bladder in patients with PBS.

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PURPOSE: To compare the structure of the testis in fetuses with prune belly syndrome (PBS) to normal controls. MATERIALS AND METHODS: We studied 6 testes obtained from 3 fetuses with PBS and 14 testes from 7 male fetuses. The testicular specimens were cut into 5-µm thick sections and stained with hematoxylin and eosin (HE), to observe the seminiferous tubules; Weigert's solution to observe elastic fibers; and picrosirius red to observe collagen. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image Pro and Image J programs. Means were statistically compared using the Mann-Whitney U test (p < 0.005). RESULTS: Quantitative analysis documented no differences (p = 0.4) in number of seminiferous tubules (ST) in PBS testes (mean = 8.87%, SD = 1.59), when compared to the control (mean = 11.4%, SD = 2.99) and no differences (p = 0.8) in diameter of ST in PBS testes (mean = 52.85 µm, SD = 1.58) when compared to the control group (mean = 53.17 µm, SD = 1.55), but we did observe a lower number (p = 0.0002) of Leydig cells in the PBS testes (mean = 67.03% and SD = 3.697) when compared to the control group (mean = 90.1% and SD = 2.986). CONCLUSIONS: Our study showed a lower concentration of Leydig cells in the triad syndrome fetuses.

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OBJECTIVES: To assess the incidence of anatomical anomalies in patients with retractile testis. MATERIALS AND METHODS: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p<0.05). RESULTS: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). CONCLUSIONS: Retractile testis is not a normal variant with a significant risk of patent processos vaginalis and epididymal anomalies.

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ABSTRACT Objectives: To assess the incidence of anatomical anomalies in patients with retractile testis. Materials and Methods: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p <0.05). Results: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). Conclusions: Retractile testis is not a normal variant with a significant risk of patent processus vaginalis and epididymal anomalies.

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OBJECTIVES: To confirm if a real inner descend of testis occurs, correlating the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring. MATERIAL AND METHODS: Twenty nine human fetuses between 13 and 23 weeks post conception (WPC) were studied. The fetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) was measured to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test. RESULTS: The 58 testes had abdominal position. The DK-T in the right side measured between 0.17 and 1.82cm (mean=0.79cm) and in the left side it was between 0.12 and 1.84cm (mean=0.87cm), without statistically differences (p=0.0557). The linear regression analysis indicated that DK-T in both sides correlated significantly and positively with fetal age. All fetuses with more than 20 WPC, heavier than 350g and with CRL over 22cm had a greater distance than the average DK-T. We xobserved that the 58 testis remains adjacent to the internal ring throughout the period studied. CONCLUSIONS: The testes remains adjacent to the internal ring throughout the period studied, indicating that there is no real trans-abdominal testicular descent during the second gestational trimester.

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ABSTRACT Objectives To confirm if a real inner descend of testis occurs, correlating the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring. Material and Methods Twenty nine human fetuses between 13 and 23 weeks post conception (WPC) were studied. The fetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) was measured to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test. Results The 58 testes had abdominal position. The DK-T in the right side measured between 0.17 and 1.82cm (mean=0.79cm) and in the left side it was between 0.12 and 1.84cm (mean=0.87cm), without statistically differences (p=0.0557). The linear regression analysis indicated that DK-T in both sides correlated significantly and positively with fetal age. All fetuses with more than 20 WPC, heavier than 350g and with CRL over 22cm had a greater distance than the average DK-T. We xobserved that the 58 testis remains adjacent to the internal ring throughout the period studied. Conclusions The testes remains adjacent to the internal ring throughout the period studied, indicating that there is no real trans-abdominal testicular descent during the second gestational trimester.

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The present study aimed to investigate the foraging dynamic of an ant community in an urban semideciduous mesophitic forest. A total of 4,297 individuals, distributed in 23 species, seven genera and four subfamilies were sampled in January, April, July and October of 2010. Four ant species guilds were found: leaf cutters, soil-dominant omnivores, soil and vegetation opportunists and large-sized epigaeic predators. There were no significant differences in total of species richness and abundance of individuals in samples among the months evaluated. However, there was a clear substitution (turnover) of species over the months. Nine species were sampled exclusively in the rainy period and five species were present only during the dry period. Thus, the species turnover over the months support the hypothesis that ant communities present a temporal dynamics in their foraging activities even in an urban forest fragment. In general, the abundance of ants foraging on soil was greatest during the months with greater rainfall. However, two species belonging to the guild of opportunistic ants from soil and vegetation doubled the number of foraging individuals in period during the months with less precipitation. These findings support that ant communities, independent of isolation and environment (urban or natural), have temporal dynamics that arise from factors relating to the biology and behavior of the group.

O presente estudo teve como objetivo investigar a dinâmica temporal do forrageamento da comunidade de formigas de um fragmento de mata mesófila semidecídual urbana. Um total de 4.297 indivíduos, distribuídos em 23 espécies, sete gêneros e quatro subfamílias foram coletados nos meses de janeiro, abril, julho e outubro de 2010. Quatro guildas de espécies de formigas foram encontradas: Cortadeiras, Onívoras dominantes de solo, Oportunistas de solo e vegetação e Predadoras epigéicas grandes. Não houve diferenças significativas na riqueza de espécies e na abundância de indivíduos encontrados nas amostras entre os meses avaliados. Entretanto, houve uma clara substituição (turnover) de espécies ao longo dos meses. Nove espécies foram amostradas exclusivamente no período chuvoso e cinco espécies no período seco. Assim, a substituição das espécies ao longo dos meses reforça a hipótese de que comunidades de formigas apresentam uma dinâmica temporal em suas atividades de forrageamento mesmo em um fragmento florestal em área urbana. No geral, a abundância de formigas forrageando no solo foi maior durante os meses de maior pluviosidade. Entretanto, duas espécies da guilda de formigas oportunistas de solo e vegetação dobraram o número de indivíduos forrageando no período de menor precipitação. Estes resultados comprovam que as comunidades de formigas, independente do isolamento e ambiente (urbano ou natural), possuem uma dinâmica temporal na atividade de forrageamento que surgem a partir de fatores relacionados com a biologia e o comportamento de cada grupo e espécie.

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